Prior authorization codes
Capital District Physicians' Health Plan, Inc. (CDPHP)
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 00001 | multicentre, phase 3 trial. Lancet Neurol. 2021 Apr;20(4):284-293. doi: 10.1016/ -4422(21) -6 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00005 | Institute-Penn Medicine Evidence-based Practice Center under Contract No. HHSA 290-2015- -I) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00006 | o Obstructive Sleep Apnea: Diagnosis and Treatment, 1370/20 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00007 | Butchbach. Available at: http://journal.frontiersin.org/article/10.3389/fmolb.2016. /full. Accessed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0001U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00020 | October 2000 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0002U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0003U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00040 | https://www.nature.com/articles/d41573-022- -2 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00045 | (Psychiatric): 1370/20 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00049 | 9. Actinic Keratoses Treatment (#CAG- ; Health Care Finance Administration | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0004M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00056 | review. Eur Urol Focus. 2021 Mar 1: -4569(21) -0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0005U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00063 | Mar;22(1):e2017. . PMID:29398898 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0006M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0007M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0007U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0008U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0009U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0010U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0011M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0011U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0012M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0013M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0016M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0016U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0017M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0017U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0018M | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0018U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0019U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0020M | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0021U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0022U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0023U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00241 | multicenter trial. The Lancet: Neurology. 2021;20(12)1012-1026. doi:10.1016/s1474-4422(21) -6 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0024U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0025U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0026U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0027U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0029U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0030U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0031U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00327 | https://www.jvascsurg.org/article/ -5214(11) -2/pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0032U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0034U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0035U | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0036U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0037U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0038U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0039U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0040U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0041U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0042T | • CT cerebral perfusion analysis | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0042U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0043U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0044U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00450 | reimbursement for electroconvulsive therapy. OEI-12-01- . Washington, DC; U.S. Department of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0045U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0046U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0047U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00487 | pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0048U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0049U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0050U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0051U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0052U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0054U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00552 | 16. Division of Managed Care Response to Coverage Question. Reference number: MA | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0055U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00562 | Diabetes Management System, Reference number: MA- , 7/22/10 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0058T | Removed termed code and replaced with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0058U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0059U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0060U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0061U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00626 | https://www.nature.com/articles/d43747-020- -y | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0062U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0063U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0064T | Uterine transplant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0064U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0065T | Uterine transplant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0065U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00661 | https://doi.org/10.1038/s41581-022- -1 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0066T | Uterine transplant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0067T | Uterine transplant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0067U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 00682 | Therapy. Transplant Cell Ther. 2024 Sep 20: -6367(24) -1 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0068T | Uterine transplant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0068U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0069T | Uterine transplant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0069U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0070U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0071T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0071U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0072T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0072U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0073U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0074U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0075T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0075U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0076T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0076U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0077U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0078U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0079U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0080U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0082U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0083U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0084U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0086U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0087U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0088U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0089U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0090U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0091U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0092U | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0093U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0094U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0095U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0096U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 01001 | http://content.onlinejacc.org/data/Journals/JAC/ / .pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0101T | Extracorporeal Shock Wave Treatment ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0101U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0102T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0102U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0103U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0105U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0106U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0107U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0108U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0109U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0110U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0111U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0112U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0113U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0114U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0115U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0116U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0117U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0118U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0119U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0120U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0121U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0122U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0123U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0126T | Removed termed code and replaced with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0129U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0130U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0133U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0134U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 01353 | 4 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0136U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0137U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0138U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 01405 | Journal Jan 2018. https://erj.ersjournals.com/content/erj/early/2018/10/25/13993003 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0140U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0141U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0142U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0152U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0153U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0154U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0155U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0156U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0157U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 01583 | trial. Lancet. 2023;402( ):1449-1458. doi:10.1016/ -6736(23) -0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0158U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0159U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 01600 | 3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0160U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0161U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0162U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0163T | Removed termed code and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0163U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0164T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0164U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0165T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0165U | (E/I) Peanut allergen-specific quantitative assessment of multiple epitopes using | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0166U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0169U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0170U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0171U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0172U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0173U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0174T | Not Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0174U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0175T | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0175U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0176U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0177U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0178U | (E/I) Peanut allergen-specific quantitative assessment of multiple epitopes using | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0179U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0180U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0181U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0182U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0183U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0184T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0184U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0185U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0186U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0187U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0188U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0189U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0190U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0191T | Effective 1/1/2022: Removed deleted code and updated | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0191U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0192U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0193U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0194U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0195U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0196U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0197U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 01987 | 8. Kang C. Lumasiran: A Review in Primary Hyperoxaluria Type 1. Drugs. 2024 Jan 22. doi: 10.1007/s40265-023- -1. 3/2024 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0198U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0199U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0200T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0200U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02017 | expanded access. Lancet. 2022 Jan 22;399( ):372-383. doi: 10.1016/ -6736(21) -1. PMID | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0201T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0201U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0202T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0203U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0205U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0206U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0207U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0209U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0210U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02110 | Vyvgart (efgartigimod) Prescribing information, Argenx US, Inc., Boston, MA . Revised 12/2021. 8/2024 8/2024 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0211U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0212U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02139 | 6 Aqvesme (mitapivat) prescribing information. Agios Pharmaceuticals, Inc. Cambridge, MA 12/2025 2/2026 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0213T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0213U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02141 | 2 Xenpozyme prescribing information, Genzyme Corporation, Cambridge, MA . 12/23 9/24 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02142 | 17 Tysabri prescribing information, Biogen Idec Inc., Cambridge, MA . 10/23 11/24 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02145 | 9 Skysona prescribing information, Bluebird Bio, Inc., Somerville, MA . 8/2025 8/2025 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0214T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0214U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0215T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0215U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0216T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0216U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0217T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0217U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0218T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0218U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0219T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0219U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0220T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0220U | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02210 | 6 Casgevy prescribing information, Vertex Pharmaceuticals Incorporated, Boston, MA . Revised 9/2025 Oct 2025 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0221T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0221U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0222T | Not Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0222U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0224U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0225U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0226U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0227U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0228U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0229U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0230U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0231U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0232T | Required Required Not Required Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0232U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0233T | Replaced deleted code with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0233U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0234U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0235U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0236U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0237U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0238U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0239U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0240U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0241U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 02421 | Lexington, MA . Revised 06/24 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0242U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0243U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0244U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0245U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0246U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0247U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0248U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0249U | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0250U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0251U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0252U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0253T | • CyPass microstent ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0253U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0254U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0255U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0256U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0257U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0258U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0259U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0260U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0261U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0262U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0263U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0264U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0265U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0266T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0266U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0267T | Removed deleted codes , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0267U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0268T | Removed deleted codes , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0268U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0269T | Removed deleted codes , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0269U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0270T | Removed deleted codes , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0270U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0271T | Removed deleted codes , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0271U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0272T | Removed deleted codes , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0272U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0273T | Removed deleted codes , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0273U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0274T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0274U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0275T | 10/28/2025 Added Renal Denervation for Uncontrolled Hypertension and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0275U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0276U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0277U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0278T | Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0278U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0279U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0280U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0281U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0282U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0283U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0284U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0285U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0286U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0287U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0288U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0289U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0290U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0291U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0292U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0293U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0294U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0295U | Required Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0296U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0297U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0298U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0299U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0300U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0301U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0302U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0303U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0304U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0305U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0306U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0307U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0308U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0309U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0310U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0311U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0312T | 4/1/2023 • Removed termed vagus nerve blocking therapy codes ( ) from | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0312U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0313T | 4/1/2023 • Removed termed vagus nerve blocking therapy codes ( ) from | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0313U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0314T | 4/1/2023 • Removed termed vagus nerve blocking therapy codes ( ) from | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0314U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0315T | 4/1/2023 • Removed termed vagus nerve blocking therapy codes ( ) from | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0315U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0316T | 4/1/2023 • Removed termed vagus nerve blocking therapy codes ( ) from | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0316U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0317T | 4/1/2023 • Removed termed vagus nerve blocking therapy codes ( ) from | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0317U | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0318U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0319U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0320U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0321U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0322U | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0323U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0326U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0327U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0328U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0329U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0330U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0331T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0331U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0332T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0332U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0333T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0333U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0334U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0335T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0335U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0336U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0337U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0338T | Not Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0338U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0339T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0339U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0340U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0341U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0342T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0342U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0343U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0344U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0345T | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0345U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0347U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0348U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0349U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0350U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0351U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0352U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0355U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0356T | 11/11/20 Removed codes for the insertion of drug-eluting implant ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0356U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0358T | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0358U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0359U | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0360U | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0361U | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0362U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0363U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0364U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0365U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0366U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0367U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0368U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0371U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0372U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0375U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0376T | Removed from exclusions codes and as these are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0376U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0377U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0378U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0379T | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0379U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0380U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0381U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0382U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0383U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0384U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0385U | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0387U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0388U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0389U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0390U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0391U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0392U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0393U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0394T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0394U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0395T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0395U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0396U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0397T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0398U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0399U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0400U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0401U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0402U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0403T | Diabetes Prevention Program ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0403U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0404T | Removed termed code and replaced it with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0404U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0405U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0406U | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0407U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0408T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0408U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0409T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0409U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0410T | Cardiac Contractility Modulation (CCM) for Heart Failure | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0410U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0411T | Cardiac Contractility Modulation (CCM) for Heart Failure | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0411U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0412U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0413U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0414U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0415U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0417T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0417U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0418T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0418U | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0419U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0420U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0421T | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0421U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0422U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0423U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0424U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0425U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0426U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0433U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0434U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0437T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0437U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0438U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0439T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0439U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0440T | Ablation, percutaneous, cryoablation Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0440U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0441T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0442T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0444U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0446T | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0447T | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0448T | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0449T | ) are considered medically necessary for any of the following indications | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0449U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0450T | Removed from exclusions codes and as these are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0452U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0453U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0454U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0455U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0456U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0460U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0461U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0462U | Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0463U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0465U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0466T | Effective 01/01/2022: Removed deleted codes -04668T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0466U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0467U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0469U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0471U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0473U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0474T | • CyPass microstent ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0474U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0475U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0476U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0477U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0478U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0479T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0480T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0480U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0481U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0483T | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0484T | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0485U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0486U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0487U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0488T | Diabetes Prevention Program ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0488U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0489U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0493U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0494U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0495U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0496U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0497U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0498U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0499U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0500T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0500U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0501T | 1/1/2024 Deleted termed codes and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0501U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0502T | 1/1/2024 Deleted termed codes and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0502U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0503T | 1/1/2024 Deleted termed codes and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0504T | 1/1/2024 Deleted termed codes and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0504U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0505U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0506U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0507U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0510U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0512U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0513U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0515T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0516T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0516U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0517T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0519T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0520T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0523T | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0523U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0525T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0529U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0530U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0532U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0533U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0534U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0536U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0537U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0538U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0539U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0540U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0543U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0544T | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0545T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0549U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0552T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0558U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0559U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0568U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0569T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0570T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0570U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0571T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0572T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0573T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0573U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0574T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0574U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0575T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0575U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0576T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0576U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0577T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0578T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0578U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0579T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0580T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0582T | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0582U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0583U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0584T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0585T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0585U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0586T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0586U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0587T | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0588T | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0589T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0590T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0591U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0592U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0594T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0596T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0596U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0597T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0597U | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0598T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0599U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0600T | Required Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0601T | Not Required Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0602U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0605U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0607T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0608T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0609T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0609U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0610T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0611T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0611U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0612T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0612U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0613U | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0614T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0615T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0619T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0620T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0623T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0624T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0625T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0626T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0627T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0628T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0629T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0630T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0631T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0632T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0633T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0634T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0635T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0636T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0637T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0638T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0639T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0640T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0644T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0645T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0646T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0647T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0648T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0649T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0651T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0652T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0653T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0654T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0655T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0656T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0657T | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0658T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0659T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0662T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0663T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0664T | Uterine Transplantation , , Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0665T | Uterine Transplantation , , Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0666T | unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0667T | unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0668T | 0670T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0669T | 0670T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0670T | Vagus nerve stimulation (VNS) 61885 VNS for treatment-resistant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0671T | ) are considered medically necessary for any of the following indications | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0672T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0673T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0683T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0684T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0685T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0686T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0687T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0688T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0689T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0690T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0691T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0692T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0693T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0694T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0695T | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0696T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0697T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0698T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0700T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0701T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0704T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0707T | Required Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0710T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0711T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0712T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0713T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0714T | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0716T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0719T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0720T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0721T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0722T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0723T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0724T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0728T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0729T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0738T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0739T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0740T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0741T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0742T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0743T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0744T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0745T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0746T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0747T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0748T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0749T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0750T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0751T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0752T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0753T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0754T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0755T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0756T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0757T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0758T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0759T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0760T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0761T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0762T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0763T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0764T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0765T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0766T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0767T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 07701 | 3 Tzield [prescribing information], Provention Bio, Inc., Red Bank, NJ . 12/2023 9/2024 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0770T | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0771T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0772T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0773T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0774T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0776T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0777T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0778T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0779T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0780T | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0781T | Not Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0782T | Not Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0783T | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0784T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0785T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0786T | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0788T | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0789T | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0790T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 07932 | 1 Mulpleta prescribing information, Shionogi Inc., Florham Park, NJ . 4/2020 9/2023 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 07936 | Jersey | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0793T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0794T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0795T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0796T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0797T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0798T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0799T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0800T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0801T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0802T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0803T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0804T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0805T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0806T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0807T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0808T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0810T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0811T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0812T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0813T | (E/I) Esophagogastroduodenoscopy, flexible, transoral, with volume adjustment of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0815T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0816T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0817T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0820T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0821T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0822T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0823T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0824T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0825T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0826T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0827T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0828T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0829T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0830T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0831T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0832T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0833T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0834T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0835T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0836T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0837T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0838T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0839T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0840T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0841T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0842T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0843T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0844T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0845T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0846T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0847T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0848T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0849T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0850T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0851T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0852T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0853T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0854T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0855T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0856T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0857T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0858T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0859T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0860T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0861T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0862T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0863T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0864T | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0865T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0866T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0867T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0868T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0869T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0870T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0871T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0872T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0873T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0874T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0875T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0876T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0877T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0878T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0879T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0880T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0881T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0884T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0885T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0886T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0888T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0889T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0890T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0891T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0892T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0893T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0897T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0898T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0899T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0900T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0901T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0902T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0903T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0904T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0905T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0906T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0907T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0908T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0909T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0910T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0911T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0912T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0913T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0914T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0915T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0916T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0917T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0918T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0919T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0920T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0921T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0922T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0923T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0924T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0925T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0926T | 0928T, 0929T, 0930T, 0931T, 0948T, 0949T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0927T | 0928T, 0929T, 0930T, 0931T, 0948T, 0949T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0928T | Extracorporeal Photopheresis for Bronchiolitis Obliterans Syndrome Following Lung Transplant: | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0929T | Extracorporeal Photopheresis for Bronchiolitis Obliterans Syndrome Following Lung Transplant: | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0930T | Extracorporeal Photopheresis for Bronchiolitis Obliterans Syndrome Following Lung Transplant: | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0931T | Extracorporeal Photopheresis for Bronchiolitis Obliterans Syndrome Following Lung Transplant: | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0932T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0933T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0934T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0935T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0936T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0937T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0938T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0939T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0940T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0941T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0942T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0943T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0944T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0945T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0946T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0947T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0948T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0949T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0950T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0951T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0952T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0953T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0954T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0955T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0956T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0957T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0958T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0959T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0960T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0961T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0962T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0963T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0964T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0965T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0966T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0967T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0968T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0969T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0970T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0971T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0972T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0973T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0974T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0975T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0976T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0977T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0978T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0979T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0980T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0981T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0982T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0983T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0986T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0987T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0988T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0989T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0990T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0991T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0992T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0993T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0994T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0995T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0996T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0997T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0998T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 0999T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1000T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1001T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1002T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1003T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10040 | Acne (L70.0-L70.9) treatment that Acne extractions/ as an initial treatment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1004T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1005T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10060 | • Incision and drainage ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10061 | • Incision and drainage ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10063 | nusinersen: a phase 2, open-label, dose-escalation study. Lancet. 2016 Dec 17; 388( ):3017 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1006T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10072 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10073 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10074 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10075 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10076 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10077 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10078 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10079 | blinded randomized trial. Can J Urol. 2020 Feb;27(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1007T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1008T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10097 | trial. Lancet. 2017;390( ):849-860. doi:10.1016/ -6736(17) -8 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1009T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1010T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1011T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1012T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1013T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1014T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1015T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1016T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1017T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1018T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1019T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10201 | 25. Medicare Part B Answer Book, Anesthesia Services, , 2001 Edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10202 | 25. Medicare Part B Answer Book, Anesthesia Services, , 2001 Edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10203 | 25. Medicare Part B Answer Book, Anesthesia Services, , 2001 Edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10204 | 25. Medicare Part B Answer Book, Anesthesia Services, , 2001 Edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10205 | 25. Medicare Part B Answer Book, Anesthesia Services, , 2001 Edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10206 | 25. Medicare Part B Answer Book, Anesthesia Services, , 2001 Edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1020T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10213 | urethral lift and Rezum steam injection. Can J Urol. 2020 Jun;27(3) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10214 | urethral lift and Rezum steam injection. Can J Urol. 2020 Jun;27(3) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10215 | urethral lift and Rezum steam injection. Can J Urol. 2020 Jun;27(3) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10216 | urethral lift and Rezum steam injection. Can J Urol. 2020 Jun;27(3) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10217 | urethral lift and Rezum steam injection. Can J Urol. 2020 Jun;27(3) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10218 | urethral lift and Rezum steam injection. Can J Urol. 2020 Jun;27(3) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10219 | urethral lift and Rezum steam injection. Can J Urol. 2020 Jun;27(3) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1021T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1022T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1023T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1024T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10253 | phase 3 trial. Lancet. 2020 Sep 12;396( ):759-769. doi: 10.1016/ -6736(20) -X. Epub | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 1025T | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10314 | Cortes J, et al. Chronic myeloid leukaemia. The Lancet. 2021 Nov 20-26;398( ):1914-1926 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10322 | expanded access. Lancet. 2022 Jan 22;399( ):372-383. doi: 10.1016/ -6736(21) -1. PMID | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10350 | 6;400( ):441-451 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10411 | trial. Lancet. 2023;402( ):1449-1458. doi:10.1016/ -6736(23) -0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10436 | 19. CMS Medicare Learning Network (MLN) Matters (MM) : New “K” Code for Therapeutic | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10441 | 25;403( ):2293-2306 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10591 | 6 Veopoz prescribing information, Regeneron Pharmaceuticals, Inc., Tarrytown, NY . Revised 3/24 8/25 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10646 | 10.1007/s00415-021- -y. Epub 2021 Jun 12. PMID: 34120208 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10960 | double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022 Feb;29(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 10968 | Gratzke C, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11021 | http://www.medicare.gov/Publications/Pubs/pdf/ .pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11055 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11056 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11057 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11200 | Skin tags that are asymptomatic. Skin tag removal only when repeatedly irritated | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11201 | Skin tags that are asymptomatic. Skin tag removal only when repeatedly irritated | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11719 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11720 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11721 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11730 | Surgical Treatment of Nails ( , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11731 | • Partial or complete avulsion ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11732 | Surgical Treatment of Nails ( , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11750 | Surgical Treatment of Nails ( , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11765 | Surgical Treatment of Nails ( , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11914 | http://www.nice.org.uk/nicemedia/live/ / / .pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11920 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11921 | for the treatment of port wine stains | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11922 | hemangiomas, or birth marks | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11950 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11951 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11952 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11954 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11960 | Tissue expander; insertion and/or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11970 | Not Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 11971 | Not Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 12110 | Latham, NY | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 13239 | TRAILBLAZER-ALZ 2 Randomized Clinical Trial. JAMA. 2023;330(6):512–527. doi:10.1001/jama.2023 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 13282 | %2c+Inc.+( %2c+A+and+B+and+HHH+MA | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 13512 | https://doi-org.gate.lib.buffalo.edu/10.1111/ctr | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 14046 | https://doi.org/10.1111/hae | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 14749 | [news release]. Genentech’s website. https://www.gene.com/media/press-releases/ /2018-10 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15010 | purpura. J Thromb Haemost. 2020;18(10):2496-2502. doi:10.1111/jth | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15203 | 6 Vyjuvek prescribing information, Krystal Biotech, Inc., Pittsburgh, PA 5/2023 3/2025 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15220 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15221 | pattern baldness or age-related hair following surgery, trauma, infection, or other | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15271 | Application of skin substitute graft to trunk, arms, legs, total wound surface area | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15272 | each additional 25 sq cm wound surface area, or part thereof | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15273 | Application of skin substitute graft to trunk, arms, legs, total wound surface area | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15274 | each additional 100 sq cm wound surface area, or part thereof, or each additional | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15275 | Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15276 | each additional 25 sq cm wound surface area, or part thereof | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15277 | Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15278 | each additional 100 sq cm wound surface area, or part thereof, or each additional | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15401 | 8. Medicare, Part B Answer Book, “Home Care Services,” pgs. , 2002 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15402 | 8. Medicare, Part B Answer Book, “Home Care Services,” pgs. , 2002 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15403 | 8. Medicare, Part B Answer Book, “Home Care Services,” pgs. , 2002 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15771 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15772 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15775 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15776 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15777 | Implantation of biologic implant (e.g., acellular dermal matrix) for soft tissue | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15778 | Implantation of absorbable mesh or other prosthesis for delayed closure of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15780 | Required Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15781 | Required Not Required Not Required Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15782 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15783 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15786 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15787 | Abrasion, lesions (e.g., keratosis, Performed due to a congenital disease or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15788 | Required Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15789 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15792 | Required Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15793 | Required Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15819 | Cervicoplasty (surgery of the neck) Cervicoplasty when performed incidental to or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15820 | Lower lid Blepharoplasty | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15821 | Lower lid Blepharoplasty | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15822 | Upper lid blepharoplasty | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15823 | Upper lid blepharoplasty | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15824 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15825 | Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15826 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15828 | Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15829 | Required Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15830 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15832 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15833 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15834 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15835 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15836 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15837 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15838 | as these are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15839 | as these are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15847 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15876 | as these are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15877 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15878 | as these are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 15879 | as these are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 16323 | AMPLATZER amulet devices in a high-risk cohort. Sci Rep. 2020 Oct 1;10(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17106 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17107 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17108 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17110 | Acne (L70.0-L70.9) treatment that Acne extractions/ as an initial treatment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17111 | does not meet criteria in next column. for severe acne will be considered medically | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17340 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17360 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 17380 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 18010 | 2 Kato GJ, Piel FB, Reid CD, et al. Sickle cell disease. Nat Rev Dis Primers. 2018;4: Oct 2023 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 18425 | specific antibody repertoire in food allergy. Sci Rep. 2019 Dec 5;9(1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 18688 | 10.1001/jama.2023. . PMID: 37768671; PMCID: PMC10540057 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19010 | 2. Siklos prescribing information, Medunik USA. Rosemont, PA 11/23 11/24 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19300 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19316 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19318 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19324 | 9/1/2021 Removed deleted CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19325 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19328 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19330 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19340 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19342 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19350 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19355 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19357 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19361 | 19364 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19364 | 19367 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19366 | 9/1/2021 Removed deleted CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19367 | 19368 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19368 | 19369 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19369 | 19380 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19370 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19371 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19380 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19396 | S2066 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19406 | 6 Hemgenix prescribing information, CSL Behring LLC, Kankakee, IL . Revised 11/2022. Reviewed 11/22 9/23 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19499 | Radiofrequency spectroscopy for Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19801 | 10. Medicare Part B Answer Book, Podiatric Services, pp. , 2001 edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19802 | 10. Medicare Part B Answer Book, Podiatric Services, pp. , 2001 edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19803 | 10. Medicare Part B Answer Book, Podiatric Services, pp. , 2001 edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19804 | 10. Medicare Part B Answer Book, Podiatric Services, pp. , 2001 edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19805 | 10. Medicare Part B Answer Book, Podiatric Services, pp. , 2001 edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 19806 | 10. Medicare Part B Answer Book, Podiatric Services, pp. , 2001 edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20024 | acute myeloid leukemia: a meta-analysis. J Natl Cancer Inst. Jan 07;96(1):38-45 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20131 | https://www.govinfo.gov/content/pkg/FR-2006-11-27/html/E6- .htm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20526 | Tendon Sheath, Ligament, Ganglion Cysts, Carpal and Tarsal Tunnel Injections ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20550 | Benefits for injection of tendons, ligaments, and bursae ( , ) are limited to three | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20551 | Benefits for injection of tendons, ligaments, and bursae ( , ) are limited to three | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20552 | Trigger Point Injections ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20553 | Trigger Point Injections ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20560 | “Dry needling” ( , ) of trigger points is considered experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20561 | “Dry needling” ( , ) of trigger points is considered experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20600 | Arthrocentesis ( , , ) is limited to three procedures every six months | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20604 | Arthrocentesis ( , , ) is limited to three procedures every six months | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20605 | Arthrocentesis ( , , ) is limited to three procedures every six months | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20606 | 21485, 21490, 29800, 29804 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20611 | 3. Medicare Part B Answer Book, Rehabilitation Services, pps , 2000 Edition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20612 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20878 | 3 Uplizna (inebilizumab-cdon) prescribing information, Viela Bio, In., Gaithersburg, MD 12/2025 2/2026 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 20999 | Extracorporeal Shock Wave Treatment ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21010 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21037 | aspects. Ann Transl Med. 2019;7(13)284. doi:10. /atm.2019.07.24 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21050 | 21485, 21490, 29800, 29804 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21060 | 21485, 21490, 29800, 29804 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21070 | 21485, 21490, 29800, 29804 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21073 | 21485, 21490, 29800, 29804 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21083 | Impression and custom preparation of Insertion or injection of prosthetic material for | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21087 | Impression and custom preparation of Insertion or injection of prosthetic material for | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21116 | 21485, 21490, 29800, 29804 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21120 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21121 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21122 | Not Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21123 | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21125 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21127 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21137 | Not Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21138 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21139 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21141 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21142 | Not Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21143 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21145 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21146 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21147 | Removed codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21150 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21151 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21154 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21155 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21159 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21160 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21172 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21175 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21179 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21180 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21181 | Required Not Required Required Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21182 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21183 | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21184 | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21188 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21193 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21194 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21195 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21196 | & | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21198 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21240 | Not Required Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21242 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21243 | Not Required Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21245 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21246 | Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21247 | congenital disease or anomaly of a covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21248 | from policy and PA requirement | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21249 | congenital disease or anomaly of a covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21270 | Not Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21280 | Canthus repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21282 | Canthus repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21480 | 21485, 21490, 29800, 29804 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21485 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21490 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21685 | • Hyoid myotomy and suspension ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21740 | Required Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21742 | Required Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 21743 | Required Required Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22206 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22207 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22210 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22212 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22214 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22220 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22222 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22224 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22505 | Required Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22510 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22511 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22513 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22514 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22526 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22527 | • Percutaneous intradiscal electrothermal annuloplasty [IDET] ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22532 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22533 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22548 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22551 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22554 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22556 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22558 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22586 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22590 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22595 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22600 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22610 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22612 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22630 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22633 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22800 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22802 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22804 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22808 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22810 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22812 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22818 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22819 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22836 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22837 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22838 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22849 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22850 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22852 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22855 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22856 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22857 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22860 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22861 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22862 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22864 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22865 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22867 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22868 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22869 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22870 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 22899 | Endoscopic or percutaneous spinal surgical Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23031 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23035 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23040 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23044 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23100 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23101 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23107 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23120 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23125 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23130 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23140 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23145 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23146 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23150 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23155 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23156 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23170 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23172 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23174 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23180 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23182 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23184 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23190 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23195 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23200 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23210 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23220 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23296 | (1) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23334 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23335 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23400 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23405 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23406 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23410 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23412 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23415 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23420 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23430 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23440 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23450 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23455 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23460 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23462 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23465 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23466 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23470 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23472 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23473 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23474 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23480 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23485 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23490 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23491 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23700 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23800 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23802 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 23929 | Superior capsular reconstruction for the , Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 24289 | http://content.onlinejacc.org/data/Journals/JAC/ / .pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 26026 | For updated guidelines, visit: https://www.guidelinecentral.com/guideline/ /#section-336178 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 26991 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 26992 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27000 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27001 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27003 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27005 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27006 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27025 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27033 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27035 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27036 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27050 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27052 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27054 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27057 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27060 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27062 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27065 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27067 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27070 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27071 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27075 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27076 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27077 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27078 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27090 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27091 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27096 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27120 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27122 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27125 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27130 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27132 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27134 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27137 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27138 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27140 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27146 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27147 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27151 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27156 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27161 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27165 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27170 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27175 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27176 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27177 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27178 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27179 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27181 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27185 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27187 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27275 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27278 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27279 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27280 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27282 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27284 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27286 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27301 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27303 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27310 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27329 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27331 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27332 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27333 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27334 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27335 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27340 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27347 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27355 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27356 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27357 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27360 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27364 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27365 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27372 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27403 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27405 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27407 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27409 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27412 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27415 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27416 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27418 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27420 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27422 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27424 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27425 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27427 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27428 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27429 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27437 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27438 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27440 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27441 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27442 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27443 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27446 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27447 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27454 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27455 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27457 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27465 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27466 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27470 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27472 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27486 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27487 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27488 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27495 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27516 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27517 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27519 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27570 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27580 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27707 | 2 Doptelet prescribing information. AkaRx, Inc., Durham, NC 7/2021 9/2023 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 27853 | NURTURE study. Muscle Nerve. 2023 Aug;68(2):157-170. doi: 10.1002/mus. . Epub 2023 Jul | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 28529 | details.aspx?LCDId= &ContrId=301&ver=96&ContrVer=1&CntrctrSelected=301*1&Cnt | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 28890 | Extracorporeal Shock Wave Treatment ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 28899 | any condition including, but not limited to, unproven; there is insufficient evidence | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29313 | long-term management. Hepatology. 2017;66(4):1314-1322. doi:10.1002/hep | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29800 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29804 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29805 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29806 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29807 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29819 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29820 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29821 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29822 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29823 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29824 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29825 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29827 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29828 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29850 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29851 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29855 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29856 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29860 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29861 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29862 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29863 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29866 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29867 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29868 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29870 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29871 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29873 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29874 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29875 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29876 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29877 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29879 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29880 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29881 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29882 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29883 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29884 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29885 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29886 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29887 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29888 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29889 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29914 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29915 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29916 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 29999 | Superior capsular reconstruction for the , Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30080 | 4. Rystiggo Prescribing Information. UCB, Inc. Smyrna, GA 3/25 7/25 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30098 | http://jcsm.aasm.org/ViewAbstract.aspx?pid= | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30117 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30178 | 2019 Sep 17. pii: -1161(19) -3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30400 | Required Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30410 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30420 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30430 | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30435 | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30450 | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30460 | Removed codes and from requiring a PA as these | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30462 | Removed codes and from requiring a PA as these | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30468 | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30469 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30767 | non-invasive tests. Am J Surg. 2020 Nov 25: -9610(20) -4 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30801 | Radiofrequency Tissue Volume Reduction Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 30999 | Balloon Septoplasty Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31231 | Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31237 | Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31242 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31243 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31299 | Unlisted procedure, accessory sinuses (when specified as insertion of drug-eluding | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31570 | Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31571 | Required Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31574 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31627 | Required Not Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31660 | ( , ) as this procedure is also listed on the Non-Covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31661 | ( , ) as this procedure is also listed on the Non-Covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31792 | phase 3 trial. Lancet. 2020 Sep 12;396( ):759-769. doi: 10.1016/ -6736(20) -X. Epub | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 31868 | trial. Lancet. 2017;390( ):849-860. doi:10.1016/ -6736(17) -8 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 32851 | Lung transplant, single; without cardiopulmonary bypass | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 32852 | Lung transplant, single; with cardiopulmonary bypass | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 32853 | Lung transplant, double (bilateral, sequential, or en bloc); without cardiopulmonary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 32854 | Lung transplant, double (bilateral, sequential, or en bloc); with cardiopulmonary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 32855 | Backbench standard preparation of cadaver donor lung allograft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 32856 | Backbench standard preparation of cadaver donor lung allograft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33202 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33203 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33206 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33207 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33208 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33210 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33211 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33212 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33213 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33214 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33215 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33216 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33217 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33218 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33220 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33221 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33222 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33223 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33224 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33226 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33227 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33228 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33229 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33230 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33231 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33233 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33234 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33235 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33236 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33237 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33238 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33240 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33241 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33243 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33244 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33249 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33262 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33263 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33264 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33267 | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33268 | Exclusion of left atrial appendage, open, performed at the time of other sternotomy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33269 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33270 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33271 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33272 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33273 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33274 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33275 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33285 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33286 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33289 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33340 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33361 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33362 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33363 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33364 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33365 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33366 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33367 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33368 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33369 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33370 | Not Required Not Required Not Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33394 | database/view/lcd.aspx?lcdid= &ver=54&= | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33398 | https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid= &ver=32&bc=0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33399 | database/view/lcd.aspx?lcdid= &ver=14&bc=0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33418 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33419 | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33477 | TPVR | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33611 | details.aspx?LCDId= &ContrId=389 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33631 | details.aspx?LCDId= &ContrId=298&ver=26&ContrVer=1&CntrctrSelected=298*1&Cnt | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33718 | https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId= | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33927 | Total replacement heart system (artificial heart) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33928 | Total replacement heart system (artificial heart) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33929 | Total replacement heart system (artificial heart) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33933 | Backbench standard preparation of cadaver donor heart/lung allograft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33935 | Heart-lung transplant with recipient cardiectomy-pneumonectomy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33944 | Backbench standard preparation of cadaver donor heart/lung allograft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33945 | Heart transplant, with or without recipient cardiectomy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33975 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33976 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33977 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33978 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33979 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33980 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33981 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33982 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33983 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33990 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33991 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33992 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33993 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33995 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 33997 | Percutaneous ventricular assist device | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 34841 | Not Required Not Required Not Required Not Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 34842 | Not Required Not Required Not Required Not Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 34843 | Not Required Not Required Not Required Not Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 34844 | Not Required Not Required Not Required Not Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 34846 | Not Required Not Required Not Required Not Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 34847 | Not Required Not Required Not Required Not Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 34848 | Not Required Not Required Not Required Not Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 35001 | details.aspx?LCDId= &ContrId=301&ver=4&ContrVer=1&CntrctrSelected=301*1&Cntr | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 35338 | details.aspx?LCDId= &ContrId=301&ver=5&ContrVer=1&CntrctrSelected=301*1&Cntr | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36465 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36466 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36468 | Sclerotherapy for telangiectasia • Sclerotherapy as a medically necessary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36469 | 9/1/2021 Removed deleted CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36470 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36471 | Not Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36473 | • mechanochemical ablation: (i.e., , ablation therapy is limited to Medicare | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36474 | • mechanochemical ablation: (i.e., , ablation therapy is limited to Medicare | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36482 | Required Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36483 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 36522 | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37241 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37242 | Vascular embolization or occlusion, inclusive of all radiological supervision and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37243 | Vascular embolization or occlusion, inclusive of all radiological supervision and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37244 | LCD : Micro-Invasive Glaucoma Surgery (NGS) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37262 | 37269 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37269 | Iontophoresis for primary focal hyperhidrosis 97033 Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37279 | POLICY NAME: NON-COVERED TECHNOLOGIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37788 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 37790 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38205 | Blood-derived hematopoietic progenitor cell harvesting for transplantation, per | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38206 | Blood-derived hematopoietic progenitor cell harvesting for transplantation, per | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38210 | Transplant preparation of hematopoietic progenitor cells; specific cell depletion | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38211 | tumor cell depletion | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38212 | Transplant preparation of hematopoietic progenitor cells; red blood cell removal | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38213 | Transplant preparation of hematopoietic progenitor cells; platelet depletion | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38225 | Harvesting of blood-derived T lymphocytes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38226 | Preparation for transport (e.g., cryopreservation) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38227 | Receipt and preparation of CAR-T cells | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38228 | Administration of CAR-T cells | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38230 | Bone marrow harvesting for transplantation, allogeneic | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38232 | Bone marrow harvesting for transplantation, autologous | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38240 | Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38241 | Hematopoietic progenitor cell (HPC); autologous transplantation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38242 | Allogeneic lymphocyte infusions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 38243 | Hematopoietic progenitor cell (HPC); HPC boost | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 39036 | coverage-database/view/lcd.aspx?lcdid= &ver=8&bc=0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 39075 | database/view/lcd.aspx?lcdid= &ver=7&keyword=fractional%20flow&keywordType | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 39455 | database/view/lcd.aspx?lcdid= &ver=4&keyword=sacroiliac&keywordType=starts&areaId | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 39662 | database/view/lcd.aspx?lcdid= &ver=5&bc=0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 41120 | **Full classification criteria may be found at: https://acrjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/art | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 41512 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 41530 | Not Required Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 41632 | 10.1002/art. . Epub 2021 Apr 23. PMID: 33474834; PMCID: PMC8169527 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 42145 | • Surgical treatments | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 42299 | •Injection snoreplasty ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43201 | Endoscopic treatment for gastroesophageal Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43210 | Not Required Not Required Not Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43236 | System, Stretta® System, Enteryx™) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43257 | therapy) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43284 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43285 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43290 | (E/I) Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43291 | (E/I) Esophagogastroduodenoscopy, flexible, transoral; with removal of intragastric | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43497 | Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43644 | Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43645 | with gastric bypass and small intestine reconstruction to limit absorption | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43647 | *No change to • Gastric electrical stimulation (GES) or gastric pacing ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43648 | *No change to • Gastric electrical stimulation (GES) or gastric pacing ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43659 | effective date • Added misc. codes and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43770 | Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43771 | revision of adjustable gastric restrictive device component only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43772 | removal of adjustable gastric restrictive device component only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43773 | removal and replacement of adjustable gastric restrictive device component | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43774 | removal of adjustable gastric restrictive device and subcutaneous port | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43775 | Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43842 | Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43843 | other than vertical-banded gastroplasty | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43845 | Gastric restrictive procedure with partial gastrectomy, pylorus-preserving | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43846 | Gastric restrictive procedure, with gastric bypass for morbid obesity; with short | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43847 | with small intestine reconstruction to limit absorption | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43848 | Revision, open, of gastric restrictive procedure for morbid obesity, other than | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43860 | Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43865 | Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43881 | effective date , , , , , , , ) as this is listed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43882 | effective date , , , , , , , ) as this is listed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43886 | Gastric restrictive procedure, open; revision of subcutaneous port component only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43887 | removal of subcutaneous port component only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43888 | removal and replacement of subcutaneous port component only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43889 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 43999 | effective date • Added misc. codes and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 44103 | 7 Zevaskyn prescribing information, Abeona Therapeutics Inc., Cleveland, OH . 8/2025 8/2025 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 44120 | Enterectomy, resection of small intestine; single resection and anastomosis | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 44121 | Enterectomy; each additional resection and anastomosis (List separately in addition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 44125 | Enterectomy, resection of small intestine; with enterostomy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 44135 | Intestinal allotransplantation from a cadaver donor | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 44136 | (E/I) Intestinal allotransplantation from a living donor | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 44137 | Removal of transplanted intestinal allograft, complete | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 46999 | Anoscopy, with delivery of thermal energy to Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47000 | Biopsy of liver, needle; percutaneous | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47001 | Biopsy of liver, needle; when done for indicated purpose at time of other major | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47100 | Biopsy of liver, wedge | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47133 | Donor hepatectomy (including cold preservation), from cadaver donor | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47135 | Liver allotransplantation; orthotopic, partial or whole, from cadaver or living donor | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47140 | Donor hepatectomy (including cold preservation), from living donor; left lateral | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47141 | Donor hepatectomy (including cold preservation), from living donor; total left | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47142 | Donor hepatectomy (including cold preservation), from living donor; total right | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47143 | Backbench standard preparation of cadaver donor whole liver graft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47144 | Backbench standard preparation of cadaver donor whole liver graft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47145 | Backbench standard preparation of cadaver donor whole liver graft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47146 | Backbench reconstruction of cadaver or living donor liver graft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47147 | Backbench reconstruction of cadaver or living donor liver graft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 47379 | Unlisted laparoscopic procedure, liver | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 48160 | Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 48552 | Backbench reconstruction of cadaver donor pancreas allograft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 48554 | Transplantation of pancreatic allograft | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 48556 | Removal of transplanted pancreatic allograft | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49560 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49561 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49562 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49563 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49564 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49565 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49566 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49568 | • Removed deleted codes , and replaced with codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49591 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49592 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49593 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49594 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49595 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49596 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49600 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49605 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49606 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49610 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49611 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49612 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49613 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49614 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49615 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49616 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49617 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 49618 | • Added new codes A2019-A2021 and Q4265-Q4271 to exclusions section. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50300 | Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50320 | Donor nephrectomy (including cold preservation); open, from living donor | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50323 | Backbench standard preparation of cadaver donor renal allograft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50325 | Backbench standard preparation of living donor renal allograft (open or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50327 | Backbench reconstruction of cadaver or living donor renal allograft prior to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50340 | Recipient nephrectomy (separate procedure) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50360 | Renal allotransplantation, implantation of graft; without recipient nephrectomy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50365 | Renal allotransplantation, implantation of graft; with recipient nephrectomy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50370 | Removal of transplanted renal allograft | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50380 | Renal auto-transplantation, reimplantation of kidney | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50542 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50592 | Required Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 50593 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 51784 | • No additional benefits are available for electromyography ( , ) when | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 51785 | • No additional benefits are available for electromyography ( , ) when | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 51974 | details.aspx?articleId= &ver=19&ContrId=298&ContrVer=1&CntrctrSelected=298*1&Cn | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 52284 | (E/I) Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 52441 | Cystourethroscopy, with insertion of permanent adjustable transprostatic implant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 52442 | Cystourethroscopy, with insertion of permanent adjustable transprostatic implant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 52443 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 52597 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 52837 | details.aspx?articleId= &ver=15&Cntrctr=275 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53032 | database/view/article.aspx?articleid= &ver=118&keyword=self%20administered&keyword 9/2025 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53451 | Periurethral transperineal adjustable balloon Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53452 | continence device (e.g., ProAct, ACT unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53453 | therapy systems) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53454 | Platelet-rich plasma (PRP) therapy 0232T Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53852 | Radiofrequency ablation for the treatment of Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53854 | Required Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53860 | Transurethral, radiofrequency micro- Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53865 | (E/I) Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 53866 | (E/I) Catheterization with removal of temporary device for ischemic remodeling (ie | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54150 | Circumcision performed post-newborn Circumcision performed beyond the newborn | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54161 | Circumcision performed post-newborn Circumcision performed beyond the newborn | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54230 | • Cavernosometry or cavernosography ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54231 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54240 | • Penile plethysmography ( ) is generally redundant clinical information and is therefore | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54250 | • Nocturnal penile tumescence and/or rigidity testing ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54400 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54401 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54405 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54406 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54408 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54410 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54411 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54415 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54416 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54417 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 54660 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 55400 | CDPHP considers vasovasostomy and vasovasorrhaphy ( ) non-covered procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 55870 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 55874 | Removed code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 55877 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 55970 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 55980 | Required Required Not Required Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 56195 | details.aspx?articleId= &ver=31&Cntrctr=297&ContrVer=1&CntrctrSelected=297*1&Do | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 56620 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58321 | Intra-uterine/intra-cervical Insemination | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58322 | Intra-uterine/intra-cervical Insemination | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58323 | Intra-uterine/intra-cervical Insemination | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58580 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58611 | http://www.nice.org.uk/nicemedia/live/ / / .pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58674 | Required Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58970 | invitro-fertilization (IVF) services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58974 | invitro-fertilization (IVF) services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 58976 | • Gamete intrafallopian transfer (GIFT) and follicle aspiration ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 60015 | 4 Zolgensma Prescribing Information, AveXis, Inc., Bannockburn, IL . 2/2025 8/2025 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 60045 | 1 Tepezza prescribing information, Horizon Therapeutics USA, Inc., Lake Forest, IL . Revised 1/2020. 7/23 1/25 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 60660 | Radiofrequency ablation of thyroid nodule(s) / Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 60661 | Radiofrequency ablation of thyroid nodule(s) / Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61715 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61796 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61797 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61798 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61799 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61800 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61885 | Vagus Nerve Stimulation (VNS) for Treatment Resistant Depression (TRD) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61886 | Vagus Nerve Stimulation (VNS) for Treatment Resistant Depression (TRD) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61888 | 0912T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 61958 | NDC: -2901-1 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62263 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62264 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62287 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62320 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62321 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62322 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62323 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62324 | Fluoroscopic guidance ( ) is considered an integral part of the injection procedure | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62326 | ) and therefore, is not separately reimbursed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62327 | ) and therefore, is not separately reimbursed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62330 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62331 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62350 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62351 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62352 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62353 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62354 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62355 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62356 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62357 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62358 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62359 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62360 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62361 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62362 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62363 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62364 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62365 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62366 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62367 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62368 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62369 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62370 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 62380 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63001 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63003 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63005 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63011 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63012 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63015 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63016 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63017 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63020 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63030 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63032 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63040 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63042 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63045 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63046 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63047 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63050 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63051 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63055 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63056 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63064 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63075 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63077 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63081 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63085 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63087 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63090 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63101 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63102 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63185 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63190 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63191 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63200 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63250 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63251 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63252 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63300 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63301 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63302 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63303 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63304 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63305 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63306 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63307 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63620 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63621 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63650 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63655 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63661 | Spinal Cord (Dorsal Column) Stimulator ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63662 | Spinal Cord (Dorsal Column) Stimulator ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63663 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63664 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63685 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 63688 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64400 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64405 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64415 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64416 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64417 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64418 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64420 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64421 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64425 | Peripheral Nerve Blocks ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64430 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64445 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64446 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64447 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64448 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64449 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64450 | Nerve blocks (CPT ), when performed at the same session as a surgical procedure, are | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64451 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64454 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64455 | Therapeutic injections for neuroma ( , ) will be limited to three injections within six | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64479 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64480 | Epidural Steroid Injections (ESI) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64483 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64484 | Epidural Steroid Injections (ESI) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64490 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64491 | Facet Joint Interventions ( , , , ) ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64492 | Facet Joint Interventions ( , , , ) ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64493 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64494 | Facet Joint Interventions ( , , , ) ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64495 | Facet Joint Interventions ( , , , ) ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64550 | 9/1/2021 Removed termed code from Procedure Codes section | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64555 | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64566 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64567 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64568 | Required Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64569 | Not Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64570 | Not Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64575 | ( , , , , , ) is considered experimental for any indication | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64580 | L8689), when used in the treatment of spinal cord and head | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64582 | • Surgical treatments | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64583 | • Surgical treatments | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64584 | • Surgical treatments | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64585 | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64590 | effective date , , , , , , , ) as this is listed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64595 | effective date , , , , , , , ) as this is listed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64624 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64625 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64628 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64629 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64632 | Therapeutic injections for neuroma ( , ) will be limited to three injections within six | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64633 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64634 | Facet Joint Interventions ( , , , ) ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64635 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64636 | Facet Joint Interventions ( , , , ) ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64640 | 6/1/2023 Removed codes and in the therapeutic injections | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64654 | Baroreflex stimulation implanted device (i.e., Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 64999 | Exclusions and replaced with existing code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65760 | refractive errors ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65765 | refractive errors ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65767 | refractive errors ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65770 | refractive errors ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65771 | refractive errors ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65772 | refractive errors ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65775 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65778 | Placement of amniotic membrane on the ocular surface; without sutures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65779 | Single layer, sutured | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65780 | Ocular surface reconstruction; amniotic membrane transplantation, multiple | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65781 | Limbal stem cell allograft (e.g., cadaveric or living donor) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 65782 | Limbal conjunctival autograft (includes obtaining graft) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 66170 | Trabeculectomy (CPT® and ), an invasive procedure, is the current standard | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 66172 | Trabeculectomy (CPT® and ), an invasive procedure, is the current standard | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 66183 | Aqueous shunts/aqueous drainage devices (CPT®/HCPCS Codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 66658 | Availability 10 mg/2 mL single-dose vial (NDC -501-01) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 66989 | Aqueous shunts/aqueous drainage devices (CPT®/HCPCS Codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 66991 | Aqueous shunts/aqueous drainage devices (CPT®/HCPCS Codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 66999 | Viscocanalostomy Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67183 | 2025. Consistent with policies adopted in the CY 2016 and CY 2023 ESRD PPS final rules (see 80 FR and 87 FR ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67900 | Brow ptosis repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67901 | Blepharoptosis (upper eyelid ptosis) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67902 | Blepharoptosis (upper eyelid ptosis) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67903 | Blepharoptosis (upper eyelid ptosis) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67904 | Blepharoptosis (upper eyelid ptosis) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67905 | ( ), upper eyelid blepharoplasty is not eligible for separate reimbursement | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67906 | Blepharoptosis (upper eyelid ptosis) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67907 | ( ), upper eyelid blepharoplasty is not eligible for separate reimbursement | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67908 | Blepharoptosis (upper eyelid ptosis) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67909 | Blepharoptosis (upper eyelid ptosis) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67911 | Eyelid (upper/lower) retraction | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67914 | Eyelid (upper/lower) ectropion or entropion repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67915 | Eyelid (upper/lower) ectropion or entropion repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67916 | Eyelid (upper/lower) ectropion or entropion repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67917 | Eyelid (upper/lower) ectropion or entropion repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67921 | Eyelid (upper/lower) ectropion or entropion repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67922 | Eyelid (upper/lower) ectropion or entropion repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67923 | Eyelid (upper/lower) retraction: 67911 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67924 | Eyelid (upper/lower) retraction: 67911 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 67999 | Brow ptosis repair | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 68306 | Available at: http://www.nice.org.uk/Docref.asp?d= | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 68841 | Removed code as this is now in the Vision Services By | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69025 | 2025. Consistent with policies adopted in the CY 2016 and CY 2023 ESRD PPS final rules (see 80 FR and 87 FR ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69090 | • Ear or body piercing ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69300 | Required Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69705 | Nasopharyngoscopy, surgical, with dilation of Eustachian tube (i.e., balloon | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69706 | Nasopharyngoscopy, surgical, with dilation of Eustachian tube (i.e., balloon | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69710 | Implantation or replacement of electromagnetic bone conduction hearing device in | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69711 | Removal or repair of electromagnetic bone conduction hearing device in temporal | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69714 | Implantation, osseointegrated implant, skull; with percutaneous attachment to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69715 | 3/1/2022 • Removed deleted code (deleted code effective 1/1/2022) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69716 | Implantation, osseointegrated implant, skull; with magnetic transcutaneous | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69717 | Replacement (including removal of existing device), osseointegrated implant; skull | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69719 | Replacement (including removal of existing device), osseointegrated implant, skull | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69726 | Removal, entire osseointegrated implant, skull; with percutaneous attachment to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69727 | Removal, entire osseointegrated implant, skull; with magnetic transcutaneous | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69728 | Removal, entire osseointegrated implant, skull; with magnetic transcutaneous | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69729 | Implantation, osseointegrated implant, skull; with magnetic transcutaneous | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69730 | Replacement (including removal of existing device), osseointegrated implant, skull | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69799 | Unlisted procedure, middle ear | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 69930 | Cochlear device implantation, with or without mastoidectomy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70336 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70450 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70460 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70470 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70471 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70472 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70473 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70480 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70481 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70482 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70486 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70487 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70488 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70490 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70491 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70492 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70496 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70498 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70540 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70542 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70543 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70544 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70545 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70546 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70547 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70548 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70549 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70551 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70552 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70553 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70554 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 70555 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71250 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71260 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71270 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71271 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71275 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71550 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71551 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71552 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 71555 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72125 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72126 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72127 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72128 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72129 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72130 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72131 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72132 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72133 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72141 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72142 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72146 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72147 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72148 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72149 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72156 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72157 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72158 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72159 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72191 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72192 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72193 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72194 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72195 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72196 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72197 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72198 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 72275 | Removed section on termed code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73200 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73201 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73202 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73206 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73218 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73219 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73220 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73221 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73222 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73223 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73225 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73600 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73601 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73602 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73603 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73604 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73605 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73606 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73607 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73608 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73609 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73610 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73620 | Benefits will be provided for foot and ankle X-rays only (CPT codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73660 | ), and are subject to the following | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73700 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73701 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73702 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73706 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73718 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73719 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73720 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73721 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73722 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73723 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 73725 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74150 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74160 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74170 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74174 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74175 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74176 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74177 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74178 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74181 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74182 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74183 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74185 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74261 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74262 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74263 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74445 | • Cavernosometry or cavernosography ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 74712 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75557 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75559 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75561 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75563 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75571 | • CT Heart, including quantitative evaluation of coronary calcium | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75572 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75573 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75577 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75580 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 75635 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76120 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76125 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76376 | CT, MRI, ultrasound, or other tomographic modality | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76377 | CT, MRI, ultrasound, or other tomographic modality | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76380 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76390 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76391 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76497 | • Virtual Bronchoscopy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76498 | • MRI 3 tesla (3T) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76882 | Ultrasound of the foot ( ) is considered to be an integral part of the ultrasonic guidance for | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 76942 | needle placement ( ) and therefore is not separately reimbursed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77003 | Fluoroscopic guidance ( ) is considered an integral part of the injection procedure | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77046 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77047 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77048 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77049 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77084 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77085 | Vertebral fracture assessment (VFA) Screening for vertebral fractures using | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77086 | dual X-ray absorptiometry (DXA) as a | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77371 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77372 | Stereotactic radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77373 | Stereotactic body radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77432 | Stereotactic body radiosurgery: 77373, 77435 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77435 | Stereotactic body radiosurgery | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77436 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77437 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77438 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77439 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77520 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77522 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77523 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 77525 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78429 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78430 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78431 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78432 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78433 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78451 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78452 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78453 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78454 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78459 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78466 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78468 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78469 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78472 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78473 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78481 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78483 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78491 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78492 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78494 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78608 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78609 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78811 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78812 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78813 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78814 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78815 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78816 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 78999 | Positron emission tomography (FDG) for Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 80305 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 80306 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 80307 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81105 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81106 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81107 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81108 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81109 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81110 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81111 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81112 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81120 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81121 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81161 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81162 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81163 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81164 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81165 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81166 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81167 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81168 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81170 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81171 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81172 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81173 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81174 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81175 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81176 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81177 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81178 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81179 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81180 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81181 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81182 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81183 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81184 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81185 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81186 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81187 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81188 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81189 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81190 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81191 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81192 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81193 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81194 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81195 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81200 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81201 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81202 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81203 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81204 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81205 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81206 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81207 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81208 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81209 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81210 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81212 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81215 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81216 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81217 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81218 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81219 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81221 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81222 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81223 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81224 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81225 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81226 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81227 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81228 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81229 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81230 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81231 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81232 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81233 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81234 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81235 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81236 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81237 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81238 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81239 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81240 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81241 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81242 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81243 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81244 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81245 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81246 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81247 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81248 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81249 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81250 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81251 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81252 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81253 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81254 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81255 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81256 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81257 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81258 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81259 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81260 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81261 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81262 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81263 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81264 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81265 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81266 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81267 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81268 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81269 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81270 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81271 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81272 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81273 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81274 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81275 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81276 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81277 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81278 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81279 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81283 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81284 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81285 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81286 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81287 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81288 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81289 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81290 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81291 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81292 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81293 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81294 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81295 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81296 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81297 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81298 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81299 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81300 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81301 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81302 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81303 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81304 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81305 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81306 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81307 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81308 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81309 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81310 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81311 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81312 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81313 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81314 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81315 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81316 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81317 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81318 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81319 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81320 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81321 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81322 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81323 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81324 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81325 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81326 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81327 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81328 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81330 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81331 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81332 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81333 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81334 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81335 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81336 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81337 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81338 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81339 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81340 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81341 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81342 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81343 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81344 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81345 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81346 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81347 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81348 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81349 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81350 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81351 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81352 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81353 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81354 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81355 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81357 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81360 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81361 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81362 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81363 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81364 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81370 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81371 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81372 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81373 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81374 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81375 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81376 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81377 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81378 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81379 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81380 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81381 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81382 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81383 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81400 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81401 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81402 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81403 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81404 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81405 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81406 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81407 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81408 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81410 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81411 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81412 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81413 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81414 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81415 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81416 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81417 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81418 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81419 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81422 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81425 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81426 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81427 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81430 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81431 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81432 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81434 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81435 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81436 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81437 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81439 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81440 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81441 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81442 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81443 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81445 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81448 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81449 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81450 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81451 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81455 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81456 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81457 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81458 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81459 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81460 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81462 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81463 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81464 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81465 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81470 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81471 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81479 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81490 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81493 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81504 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81507 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81518 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81519 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81520 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81521 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81522 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81523 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81524 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81525 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81529 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81540 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81541 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81542 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81546 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81551 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81552 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81554 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81558 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81595 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 81599 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 82785 | Gammaglobulin (immunoglobulin), IgE | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 83987 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 84999 | Avise PG to measure methotrexate Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86001 | (E/I) Allergen-specific IgG; quantitative or semiquantitative, each allergen | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86003 | Allergen-specific IgE; quantitative or semiquantitative, crude allergen extract, each | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86005 | Allergen-specific IgE; qualitative, multi-allergen screen (e.g., disk, sponge, card) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86008 | Allergen-specific IgE; quantitative or semiquantitative, recombinant or purified | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86152 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86153 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86343 | (E/I) Leukocyte histamine release test (LHR) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86701 | ( ), when part of a family planning visit from any | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 86849 | Antiprothrombin (phospholipid cofactor) Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88104 | Oral brush biopsy (e.g., Oral CDx) for The sensitivity and specificity of the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88141 | Pap Smears for members under 21 years of , Considered not medically necessary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88142 | Pap Smears for members under 21 years of , Considered not medically necessary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88143 | age , except in the following circumstances | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88147 | age , except in the following circumstances | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88148 | 88152,88153, • HIV-infected women beginning in | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88150 | 88152,88153, • HIV-infected women beginning in | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88152 | • HIV-infected women beginning in | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88153 | • HIV-infected women beginning in | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88154 | adolescence | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88164 | • Sexually active immunocompromised | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88165 | • Sexually active immunocompromised | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88166 | adolescent women, including those | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88167 | adolescent women, including those | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88174 | who have received an organ | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88175 | who have received an organ | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88299 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 88749 | Skin advanced glycogen end products Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89250 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89253 | Required Not Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89254 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89255 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89258 | invitro-fertilization (IVF) services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89259 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89260 | • Sperm washing ( ), sperm isolation ( , ), sperm count | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89261 | • Sperm washing ( ), sperm isolation ( , ), sperm count | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89268 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89272 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89280 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89281 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89310 | ( , ), and repeat semen analysis ( ) may be separately reimbursed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89320 | ( , ), and repeat semen analysis ( ) may be separately reimbursed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89335 | Cryopreservation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89337 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89342 | invitro-fertilization (IVF) services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89343 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89344 | Storage | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89346 | of oocytes/embryos from a fresh retrieval ( - embryo(s) storage per year, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89352 | invitro-fertilization (IVF) services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89353 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89354 | Thawing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89356 | Invitro-fertilization | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 89398 | Cryopreservation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90503 | 3. Endari prescribing information, Emmaus Medical Inc. Torrance, CA 10/20 11/24 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90791 | Other Licensed Practitioner (OLP) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90832 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90867 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90868 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90869 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90870 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90875 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90876 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90882 | Other Licensed Practitioner (OLP) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90901 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90911 | 1/1/2020 Removed deleted code and replaced with new codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90912 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 90913 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92002 | Ophthalmological visits | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92012 | Ophthalmological visits | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92065 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92066 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92071 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92072 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92130 | 2 Filspari (sparsentan) prescribing information. Travere Therapeutics, Inc., San Diego, CA 8/2025 2/2026 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92145 | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92227 | Remote Imaging Fundus Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92228 | Photography/Retinal telescreening (i.e., unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92229 | RetinaVue™, Optomap®) Exception: Coverage for retinal | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92310 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92313 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92314 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92340 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92341 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92342 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92343 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92344 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92345 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92346 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92347 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92348 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92349 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92350 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92351 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92352 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92353 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92354 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92355 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92356 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92357 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92358 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92359 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92360 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92361 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92362 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92363 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92364 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92365 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92366 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92367 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92368 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92369 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92370 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92371 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92499 | (i.e., PROSE) ( , , , , , , ) are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92507 | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92508 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92511 | Nasopharyngoscopy with endoscope (separate procedure) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92521 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92522 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92523 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92524 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92526 | Required Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92548 | Computerized dynamic posturography Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92601 | Diagnostic analysis of cochlear implant, patient younger than 7 years of age; with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92602 | subsequent reprogramming | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92603 | Diagnostic analysis of cochlear implant, age 7 years or older; with programming | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92604 | subsequent reprogramming | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92605 | Evaluation for prescription of non-speech-generating augmentative and alternative | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92618 | each additional 30 minutes (List separately in addition to code for primary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92622 | Diagnostic analysis, programming, and verification of an auditory osseointegrated | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92623 | each additional 15 minutes (List separately in addition to code for primary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92640 | Diagnostic analysis with programming of auditory brain stem implant, per hour | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 92972 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93000 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93001 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93002 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93003 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93004 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93005 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93006 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93007 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93008 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93009 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93010 | CDPHP does not allow separate reimbursement for CPT (routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93040 | electrocardiogram) and (rhythm electrocardiogram) when billed with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93041 | electrocardiogram) and (rhythm electrocardiogram) when billed with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93042 | electrocardiogram) and (rhythm electrocardiogram) when billed with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93050 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93228 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93229 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93264 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93451 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93452 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93453 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93454 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93455 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93456 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93457 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93458 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93459 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93460 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93461 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93593 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93594 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93595 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93596 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93597 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93600 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93602 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93603 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93610 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93612 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93615 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93616 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93618 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93619 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93620 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93624 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93631 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93640 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93641 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93642 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93644 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93650 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93653 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93654 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93656 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93668 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93702 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93740 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93745 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93797 | Cardiac Rehabilitation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93798 | Cardiac Rehabilitation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 93998 | Common carotid intima-media thickness Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 94080 | 9 RITUXAN (rituximab) prescribing information, Genentech, Inc., South San Francisco, CA . 12/21 11/24 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 94625 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 94626 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 94726 | Air displacement/body plethymography for Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 94750 | code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95004 | Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95017 | Allergy testing, any combination of percutaneous (scratch, puncture, prick) and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95018 | Allergy testing, any combination of percutaneous (scratch, puncture, prick) and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95024 | Intracutaneous (intradermal) tests with allergenic extracts, immediate type | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95027 | Intracutaneous (intradermal) tests, sequential and incremental, with allergenic | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95028 | Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95044 | Patch or application test(s) (specify number of tests) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95052 | Photo patch test(s) (specify number of tests) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95056 | Photo tests | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95060 | (E/I) Ophthalmic mucous membrane tests | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95065 | (E/I) Direct nasal mucous membrane test | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95070 | Inhalation bronchial challenge testing (not including necessary pulmonary function | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95071 | 11/1/2021 • Removed termed code from Procedure Codes section | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95075 | 11/1/20 • Removed termed code from Procedure Codes section | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95076 | Ingestion challenge test (sequential and incremental ingestion of test items, e.g | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95079 | Ingestion challenge test (sequential and incremental ingestion of test items, e.g | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95165 | 9/1/2025 • Removed statement from Policy Considerations regarding as it is | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95249 | Professional glucose monitoring ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95250 | Professional glucose monitoring ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95251 | Professional glucose monitoring ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95700 | Ambulatory Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95705 | Ambulatory Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95706 | Ambulatory Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95707 | Ambulatory Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95708 | Ambulatory Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95709 | Ambulatory Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95710 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95711 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95712 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95713 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95714 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95715 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95716 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95717 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95718 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95719 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95720 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95721 | 95722, 95723, 95724, 95725, 95726 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95722 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95723 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95724 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95725 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95726 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95782 | Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95783 | Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95800 | • Unattended (home-based) sleep testing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95801 | • Unattended (home-based) sleep testing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95803 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95805 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95806 | • Unattended (home-based) sleep testing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95807 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95808 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95810 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95811 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95812 | Routine “Resting” Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95813 | Routine “Resting” Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95816 | Routine “Resting” Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95819 | Routine “Resting” Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95822 | Routine “Resting” Electroencephalography (EEG) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95925 | • Somatosensory evoked potential studies ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95926 | • Somatosensory evoked potential studies ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95970 | 0912T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95976 | 0912T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95977 | 0912T | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95980 | effective date , , , , , , , ) as this is listed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95981 | effective date , , , , , , , ) as this is listed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95982 | effective date , , , , , , , ) as this is listed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95990 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 95991 | Implantable infusion pumps ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96000 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96001 | 5/1/2020 Removed gait analysis ( ) from the Exclusions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96002 | 5/1/2020 Removed gait analysis ( ) from the Exclusions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96003 | 5/1/2020 Removed gait analysis ( ) from the Exclusions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96004 | 5/1/2020 Removed gait analysis ( ) from the Exclusions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96116 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96121 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96130 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96131 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96132 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96133 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96136 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96137 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96138 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96139 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96146 | Required Not Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96152 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96156 | 8/1/2023 Added and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96159 | 8/1/2023 Added and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96365 | Intravenous infusion (CPT) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96366 | Intravenous infusion (CPT) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96367 | Intravenous infusion (CPT) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96368 | Intravenous infusion (CPT) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96372 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96904 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96920 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96921 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 96922 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97005 | *No change to policy codes and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97006 | *No change to policy codes and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97010 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97011 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97012 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97013 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97014 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97015 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97016 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97017 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97018 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97019 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97020 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97021 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97022 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97023 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97024 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97025 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97026 | Infrared therapy used for the treatment of Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97027 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97028 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97029 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97030 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97031 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97032 | Benefits are provided for electrical stimulation ( ) when used as a means of therapeutic | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97033 | Iontophoresis for primary focal hyperhidrosis Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97034 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97035 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97036 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97037 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97038 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97039 | professional (i.e., MD, physical therapist) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97110 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97111 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97112 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97113 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97114 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97115 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97116 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97117 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97118 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97119 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97120 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97121 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97122 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97123 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97124 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97125 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97126 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97127 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97128 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97129 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97130 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97131 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97132 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97133 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97134 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97135 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97136 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97137 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97138 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97139 | Microvas vascular treatment system for Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97140 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97141 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97142 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97143 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97144 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97145 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97146 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97147 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97148 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97149 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97150 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97151 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97152 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97153 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97154 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97155 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97156 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97157 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97158 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97159 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97160 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97161 | of service as physical medicine and rehabilitation evaluation codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97162 | of service as physical medicine and rehabilitation evaluation codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97163 | of service as physical medicine and rehabilitation evaluation codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97164 | of service as physical medicine and rehabilitation evaluation codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97165 | of service as physical medicine and rehabilitation evaluation codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97166 | Evaluation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97167 | Evaluation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97168 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97169 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97170 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97171 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97172 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97173 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97174 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97175 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97176 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97177 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97178 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97179 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97180 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97181 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97182 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97183 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97184 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97185 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97186 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97187 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97188 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97189 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97190 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97191 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97192 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97193 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97194 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97195 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97196 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97197 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97198 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97199 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97200 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97201 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97202 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97203 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97204 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97205 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97206 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97207 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97208 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97209 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97210 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97211 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97212 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97213 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97214 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97215 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97216 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97217 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97218 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97219 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97220 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97221 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97222 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97223 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97224 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97225 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97226 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97227 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97228 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97229 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97230 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97231 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97232 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97233 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97234 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97235 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97236 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97237 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97238 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97239 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97240 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97241 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97242 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97243 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97244 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97245 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97246 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97247 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97248 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97249 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97250 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97251 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97252 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97253 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97254 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97255 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97256 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97257 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97258 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97259 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97260 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97261 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97262 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97263 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97264 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97265 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97266 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97267 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97268 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97269 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97270 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97271 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97272 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97273 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97274 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97275 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97276 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97277 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97278 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97279 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97280 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97281 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97282 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97283 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97284 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97285 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97286 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97287 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97288 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97289 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97290 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97291 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97292 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97293 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97294 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97295 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97296 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97297 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97298 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97299 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97300 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97301 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97302 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97303 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97304 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97305 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97306 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97307 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97308 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97309 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97310 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97311 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97312 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97313 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97314 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97315 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97316 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97317 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97318 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97319 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97320 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97321 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97322 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97323 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97324 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97325 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97326 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97327 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97328 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97329 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97330 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97331 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97332 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97333 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97334 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97335 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97336 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97337 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97338 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97339 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97340 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97341 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97342 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97343 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97344 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97345 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97346 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97347 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97348 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97349 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97350 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97351 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97352 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97353 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97354 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97355 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97356 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97357 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97358 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97359 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97360 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97361 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97362 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97363 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97364 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97365 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97366 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97367 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97368 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97369 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97370 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97371 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97372 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97373 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97374 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97375 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97376 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97377 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97378 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97379 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97380 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97381 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97382 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97383 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97384 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97385 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97386 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97387 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97388 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97389 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97390 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97391 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97392 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97393 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97394 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97395 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97396 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97397 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97398 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97399 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97400 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97401 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97402 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97403 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97404 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97405 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97406 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97407 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97408 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97409 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97410 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97411 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97412 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97413 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97414 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97415 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97416 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97417 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97418 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97419 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97420 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97421 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97422 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97423 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97424 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97425 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97426 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97427 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97428 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97429 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97430 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97431 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97432 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97433 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97434 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97435 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97436 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97437 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97438 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97439 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97440 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97441 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97442 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97443 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97444 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97445 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97446 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97447 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97448 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97449 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97450 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97451 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97452 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97453 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97454 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97455 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97456 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97457 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97458 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97459 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97460 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97461 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97462 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97463 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97464 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97465 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97466 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97467 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97468 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97469 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97470 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97471 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97472 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97473 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97474 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97475 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97476 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97477 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97478 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97479 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97480 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97481 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97482 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97483 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97484 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97485 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97486 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97487 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97488 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97489 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97490 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97491 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97492 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97493 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97494 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97495 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97496 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97497 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97498 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97499 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97500 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97501 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97502 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97503 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97504 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97505 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97506 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97507 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97508 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97509 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97510 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97511 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97512 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97513 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97514 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97515 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97516 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97517 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97518 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97519 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97520 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97521 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97522 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97523 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97524 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97525 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97526 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97527 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97528 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97529 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97530 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97531 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97532 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97533 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97534 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97535 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97536 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97537 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97538 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97539 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97540 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97541 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97542 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97543 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97544 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97545 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97546 | Therapeutic Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97607 | Required Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97608 | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97610 | Not Required Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97750 | Tests & Measurements | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97751 | ( , are non | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97752 | ( , are non | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97753 | ( , are non | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97754 | ( , are non | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97755 | Tests & Measurements | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97760 | Orthotic & Prosthetic Management | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97761 | Orthotic & Prosthetic Management | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97762 | Orthotic & Prosthetic Management | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 97763 | Orthotic & Prosthetic Management | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98940 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98941 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98942 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98943 | Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98975 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98976 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98977 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98978 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98979 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98980 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98981 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98984 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98985 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 98986 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99091 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99183 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99188 | ( , , ) for children from birth through age five when applied by a dentist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99199 | measurement of body composition (BOD- unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99202 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99203 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99204 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99205 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99206 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99207 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99208 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99209 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99210 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99211 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99212 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99213 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99214 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99215 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99216 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99217 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99218 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99219 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99220 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99221 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99222 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99223 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99224 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99225 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99226 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99227 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99228 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99229 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99230 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99231 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99232 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99233 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99234 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99235 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99236 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99237 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99238 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99239 | CDPHP will not separately reimburse for evaluation and management codes ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99281 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99282 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99283 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99284 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99285 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99286 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99287 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99288 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99289 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99290 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99291 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99292 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99293 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99294 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99295 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99296 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99297 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99298 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99299 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99300 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99301 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99302 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99303 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99304 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99305 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99306 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99307 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99308 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99309 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99310 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99311 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99312 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99313 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99314 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99315 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99316 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99317 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99318 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99319 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99320 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99321 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99322 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99323 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99324 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99325 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99326 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99327 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99328 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99329 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99330 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99331 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99332 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99333 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99334 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99335 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99336 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99337 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99338 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99339 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99340 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99341 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99342 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99343 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99344 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99345 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99346 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99347 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99348 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99349 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99350 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99351 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99352 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99353 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99354 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99355 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99356 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99357 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99358 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99359 | ) in conjunction with diabetes education ( , , ) when billed by | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99445 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99453 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99454 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99457 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99458 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99470 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99500 | prenatal or postnatal home health care nurse ( , ) visit when the woman may derive | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99501 | prenatal or postnatal home health care nurse ( , ) visit when the woman may derive | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99502 | • Other Home Health Services/Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99503 | • Other Home Health Services/Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99504 | • Other Home Health Services/Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99505 | • Other Home Health Services/Procedures | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99506 | • Physical Therapist: S9131, G0151 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99507 | • Physical Therapist: S9131, G0151 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99509 | Custodial care ( ) or rest cures and services rendered for the convenience of an enrollee | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99511 | • Physical Therapist: S9131, G0151 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99512 | • Physical Therapist: S9131, G0151 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99600 | • Physical Therapist: S9131, G0151 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99601 | • Home Infusion services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| 99602 | • Home Infusion services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0021 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0080 | wheelchair van and/or private or commercial air transportation ( – , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0090 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0100 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0110 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0120 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0130 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0140 | wheelchair van and/or private or commercial air transportation ( – , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0160 | fees, tolls, lodging, or meals for either the escort or recipient ( - ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0210 | fees, tolls, lodging, or meals for either the escort or recipient ( - ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0382 | Reimbursement for routine disposable supplies ( - , - , ) is | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0384 | Reimbursement for routine disposable supplies ( - , - , ) is | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0392 | Reimbursement for routine disposable supplies ( - , - , ) is | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0398 | Reimbursement for routine disposable supplies ( - , - , ) is | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0420 | Ambulance waiting time ( ) is not eligible for coverage | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0422 | Reimbursement for routine disposable supplies ( - , - , ) is | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0424 | No additional benefits are available for extra ambulance attendants ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0425 | Reimbursement for ground mileage ( ) will be provided in addition to the basic emergency | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0426 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0428 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0430 | Air ambulance ( , , , ) transport is considered medically necessary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0431 | Air ambulance ( , , , ) transport is considered medically necessary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0432 | Paramedic intercept services ( ) are ALS services delivered by paramedics that operate | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0434 | Specialty care transport ( ) is the inter-facility transportation of a critically injured or ill | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0435 | Air ambulance ( , , , ) transport is considered medically necessary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0436 | Air ambulance ( , , , ) transport is considered medically necessary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A0998 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2001 | (E/I) Innovamatrix ac, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2002 | (E/I) Mirragen advanced wound matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2004 | (E/I) Xcellistem, 1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2005 | (E/I) Microlyte matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2007 | (E/I) Restrata, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2008 | (E/I) TheraGenesis, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2009 | (E/I) Symphony, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2010 | (E/I) Apis, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2011 | (E/I) Supra SDRM, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2012 | (E/I) SUPRATHEL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2013 | (E/I) Innovamatrix FS, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2014 | (E/I) Omeza collagen matrix, per 100 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2015 | (E/I) Phoenix wound matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2016 | (E/I) PermeaDerm B, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2017 | (E/I) PermeaDerm glove, each | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2018 | (E/I) PermeaDerm C, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2019 | (E/I) Kerecis Omega3 MariGen shield, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2020 | (E/I) AC5 Advanced Wound System (AC5) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2021 | (E/I) NeoMatrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2022 | 10/1/2023 • Added new codes - , and - to Exclusions section | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2025 | 10/1/2023 • Added new codes - , and - to Exclusions section | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2026 | (E/I) Restrata MiniMatrix, 5 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2027 | (E/I) MatriDerm, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2028 | (E/I) MicroMatrix Flex, per mg (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2029 | (E/I) MiroTract Wound Matrix sheet, per cc (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2030 | (E/I) Miro3d fibers, per milligram (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2031 | (E/I) Mirodry wound matrix, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2032 | (E/I) Myriad matrix, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2033 | (E/I) Myriad morcells, 4 milligrams (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2034 | (E/I) Foundation drs solo, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2035 | (E/I) Corplex p or theracor p or allacor p, per milligram | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2036 | (E/I) Cohealyx Collagen Dermal Matrix, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2037 | (E/I) G4Derm Plus, per ml (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2038 | (E/I) MariGen Pacto, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A2039 | (E/I) InnovaMatrix FD, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4100 | Skin substitute, FDA-cleared as a device, not otherwise specified | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4238 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4239 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4305 | 1/1/2022 Removed / (Drug delivery system) from grid as they | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4306 | 1/1/2022 Removed / (Drug delivery system) from grid as they | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4457 | 1/1/2024 Replaced termed code with new code in Select | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4468 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4490 | Codes , , , are non-covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4495 | Codes , , , are non-covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4500 | Codes , , , are non-covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4510 | Codes , , , are non-covered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4540 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4542 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4543 | Transcutaneous Electrical Nerve Stimulator, , Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4545 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4556 | Codes (Electrodes, [e.g., apnea monitor], per pair), (conductive paste or gel), and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4558 | Codes (Electrodes, [e.g., apnea monitor], per pair), (conductive paste or gel), and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4575 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4595 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4596 | (i.e., Fisher Wallace Stimulator) including unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4606 | Pulse oximeter probes ( ) are used with the oximeter ( ) and are included in the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4630 | (replacement batteries) should not be billed separately, and no separate allowance will be | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4639 | Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A4670 | Automatic Blood Pressure Cuff ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5500 | Therapeutic Shoes for Diabetics | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5501 | Therapeutic Shoes for Diabetics | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5503 | Therapeutic Shoes for Diabetics | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5504 | bottoms ( ), wedges ( ), metatarsal bars ( ), or offset heels ( ). Other | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5505 | bottoms ( ), wedges ( ), metatarsal bars ( ), or offset heels ( ). Other | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5506 | bottoms ( ), wedges ( ), metatarsal bars ( ), or offset heels ( ). Other | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5507 | Therapeutic Shoes for Diabetics | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5508 | A deluxe feature of a diabetic shoe ( ) does not contribute to the therapeutic function of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5510 | Compression molding inserts ( ) are considered non-covered, as they do not require total | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5512 | Therapeutic Shoe Inserts | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5513 | Therapeutic Shoe Inserts | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A5514 | Therapeutic Shoe Inserts | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6448 | • | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6450 | • | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6451 | • | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6452 | • | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6515 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6519 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6520 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6529 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6530 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6533 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6538 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6540 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6544 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6545 | • | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6549 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6552 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6589 | A6593, A6610, A6611, S8420-S8428. | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6593 | The following codes will be allowed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6594 | • | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6609 | • | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6610 | The following codes will be allowed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A6611 | The following codes will be allowed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A7021 | Lung expansion airway clearance, , Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A7048 | Vacuum drainage collection unit and tubing kit ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A7049 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9272 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9274 | ➢ Omnipod Insulin Management System | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9276 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9277 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9278 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9282 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9586 | Removed from experimental services (please see | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9587 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9593 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9594 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9595 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9596 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9597 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9608 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9800 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9900 | Iontophoresis device for home use for , , Experimental, investigational or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| A9999 | hyperhidrosis (i.e., Dermadry, miraDry) unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| B9002 | • Enteral nutrition infusion pump ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1605 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1721 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1722 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1761 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1764 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1777 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1779 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1785 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1786 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1821 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1878 | lines, corners of the mouth, and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1882 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1895 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1896 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1898 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1899 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C1900 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C2596 | Probe, image guided, robotic, waterjet ablation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C2614 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C2619 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C2620 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C2621 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C2624 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C2625 | Stent, non-coronary, temporary, with delivery system (Propel™) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5271 | Application of low-cost skin substitute graft to trunk, arms, legs, total wound | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5272 | Application of low-cost skin substitute graft to trunk, arms, legs, total wound | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5273 | Application of low-cost skin substitute graft to trunk, arms, legs, total wound | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5274 | each additional 100 sq cm wound surface area, or part thereof, or each additional | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5275 | Application of low-cost skin substitute graft to face, scalp, eyelids, mouth, neck | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5276 | each additional 25 sq cm or less wound surface area, or part thereof | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5277 | Application of low-cost skin substitute graft to face, scalp, eyelids, mouth, neck | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C5278 | each additional 100 sq cm wound surface area, or part thereof, or each additional | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C7509 | Electromagnetic navigation bronchoscopy , , Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C7510 | (ENB) for peripheral lung lesions (e.g., , unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C7511 | virtual bronchoscopy) , Exception: Covered for Medicare | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C7567 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8900 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8901 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8902 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8903 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8905 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8906 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8908 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8909 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8910 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8911 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8912 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8913 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8914 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8918 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8919 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8920 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8931 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8932 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8933 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8934 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8935 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8936 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C8937 | • Computer-aided detection (CAD), breast MRI | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9047 | HCPCS | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9122 | Removed termed code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9354 | (E/I) Acellular pericardial tissue matrix of non-human origin (Veritas), per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9356 | (E/I) Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9358 | Dermal substitute, native, nondenatured collagen, fetal bovine origin (SurgiMend | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9360 | Dermal substitute, native, nondenatured collagen, neonatal bovine origin | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9363 | (E/I) Skin substitute (Integra Meshed Bilayer Wound Matrix), per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9364 | (E/I) Porcine implant, Permacol, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9727 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9734 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9739 | Cystourethroscopy, with insertion of transprostatic implant; one to three implants | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; four or more implants | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9741 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9757 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9762 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9763 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9764 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9765 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9766 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9767 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9771 | Cryoablation of the posterior nasal nerve Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9772 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9773 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9774 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9775 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9784 | (E/I) Gastric restrictive procedure, endoscopic sleeve gastroplasty, with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9785 | (E/I) Endoscopic outlet reduction, gastric pouch application, with endoscopy and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9795 | Stereotactic body radiosurgery: 77373, 77435 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9808 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9809 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| C9817 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| D1206 | ( , , ) for children from birth through age five when applied by a dentist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| D1208 | ( , , ) for children from birth through age five when applied by a dentist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| D5924 | Billing of code (cranial prosthesis) is not an appropriate code for purposes of this policy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| D7288 | screening of mouth cancer office- based test compromise ability to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| D9947 | • Oral Appliances | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| D9948 | • Oral Appliances | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| D9949 | • Oral Appliances | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0100 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0105 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0110 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0111 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0112 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0113 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0114 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0116 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0117 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0118 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0130 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0135 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0140 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0141 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0143 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0144 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0147 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0148 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0149 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0152 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0153 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0154 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0155 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0156 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0157 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0158 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0159 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0160 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0161 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0162 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0163 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0165 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0167 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0168 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0170 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0171 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0172 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0175 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0181 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0182 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0183 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0184 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0185 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0186 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0187 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0188 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0189 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0193 | Not Required Not Required Y if rental or over 1K Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0194 | Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0196 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0197 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0198 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0199 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0200 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0201 | • Penile contracture device, manual, greater than 3 lbs. traction force ( ) is considered | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0202 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0203 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0205 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0210 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0215 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0217 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0218 | Electrical water-circulating cold pad with Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0221 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0225 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0231 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0235 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0236 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0239 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0240 | Y if rental or over 1K Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0241 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0242 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0243 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0244 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0245 | Y if rental or over 1K Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0246 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0247 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0248 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0249 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0250 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0251 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0255 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0256 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0260 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0261 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0265 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0266 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0270 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0271 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0272 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0273 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0274 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0275 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0276 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0277 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0280 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0290 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0291 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0292 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0293 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0294 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0295 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0296 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0297 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0300 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0301 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0302 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0303 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0304 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0305 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0310 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0315 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0316 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0325 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0326 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0328 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0329 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0350 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0352 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0370 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Not Required Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0371 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0372 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0373 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0445 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0446 | Y if rental or over 1K Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0450 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0457 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0459 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0460 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0461 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0462 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0463 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0464 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0465 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0466 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0467 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0468 | Y if rental or over 1K Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0469 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0470 | • CPAP/BiPAP/APAP equipment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0471 | • CPAP/BiPAP/APAP equipment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0472 | • CPAP/BiPAP/APAP equipment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0480 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0481 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0482 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0483 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0484 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0485 | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0486 | Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0490 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0491 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0492 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0493 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0500 | Not Required Not Required Y if rental or over 1K Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0530 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0561 | • CPAP/BiPAP/APAP equipment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0562 | • CPAP/BiPAP/APAP equipment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0565 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0570 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0572 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0574 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0575 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0585 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0600 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0601 | • CPAP/BiPAP/APAP equipment | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0602 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0603 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0604 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0605 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0606 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0607 | Required Not Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0610 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0615 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0616 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0617 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0618 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0619 | Not Required Not Required Y if rental or over 1K Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0621 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0625 | Not Required Not Required Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0627 | Not Required Y if rental or over 1K Y if rental or over 1K Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0628 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0629 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0630 | Not Required Not Required Y if rental or over 1K Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0635 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0636 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0637 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0638 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0639 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0640 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0641 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0642 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0650 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0651 | Y if rental or over 1K Y if rental or over 1K Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0652 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0655 | Not Required Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0656 | Not Required Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0657 | Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0658 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0659 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0660 | Y if rental or over 1K Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0665 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0666 | Not Required Not Required Y if rental or over 1K Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0667 | Y if rental or over 1K Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0668 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0669 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0670 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0671 | Y if rental or over 1K Y if rental or over 1K Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0672 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0673 | Y if rental or over 1K Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0675 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0676 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0677 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0678 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0679 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0680 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0681 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0682 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0683 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0691 | Not Required Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0692 | Not Required Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0693 | Not Required Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0694 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0700 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0705 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0710 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0715 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0716 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0721 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0732 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0733 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0734 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0735 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0736 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0737 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0738 | Y if rental or over 1K Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0739 | Y if rental or over 1K Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0740 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0743 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0744 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0745 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0746 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0747 | Y if rental or over 1K Y if rental or over 1K Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0748 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0749 | Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0755 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0760 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0761 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0762 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0764 | Y if rental or over 1K Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0765 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0766 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0767 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0769 | Not Required Y if rental or over 1K Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0770 | Not Required Not Required Not Required Not Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0776 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0779 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0780 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0781 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0782 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0783 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0784 | • Insulin pumps ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0787 | Y if rental or over 1K Not Required Y if rental or over 1K Y if rental or over 1K Not Required Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0791 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0830 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0840 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0849 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0850 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0855 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0856 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0860 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0870 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0880 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0890 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0900 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0910 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0911 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0912 | Not Required Not Required Y if rental or over 1K Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0920 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0930 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0935 | Not Required Not Required Y for purchases over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0936 | Y if rental or over 1K Y if rental or over 1K Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0940 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0941 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0942 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0944 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0945 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0946 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0947 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0948 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0950 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0951 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0952 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0953 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0954 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0955 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0956 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0957 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0958 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0959 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0960 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0961 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0966 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0967 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0968 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0969 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0970 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0971 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0973 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0974 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0978 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0980 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0981 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0982 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0983 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0984 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0985 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0986 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0988 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0990 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0992 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0994 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E0995 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1002 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1003 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1004 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1005 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1006 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1007 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1008 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1009 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1010 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1011 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1012 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1014 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1015 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1016 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1017 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1018 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1020 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1028 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1029 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1030 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1031 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1035 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1036 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1037 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1038 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1039 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Not Required Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1050 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1060 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1070 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1083 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1084 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1085 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1086 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1087 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1088 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1089 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1090 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1092 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1093 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1100 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1110 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1130 | Required Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1140 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1150 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1160 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1161 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1170 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1171 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1172 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1180 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1190 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1195 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1200 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1220 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1221 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1222 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1223 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1224 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1225 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1226 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1227 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1228 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1229 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1230 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1231 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1232 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1233 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1234 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1235 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1236 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1237 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1238 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1239 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1240 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1250 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1260 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1270 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1280 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1285 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1290 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1295 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1296 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1297 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1298 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1300 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1301 | Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1310 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1352 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1372 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1399 | Interferential stimulation Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1500 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1510 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1520 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1530 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1540 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1550 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1560 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1570 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1575 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1580 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1590 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1592 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1594 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1600 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1610 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1615 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1620 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1625 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1629 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1630 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1632 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1634 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1635 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1636 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1637 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1639 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1699 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1700 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1701 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1702 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1800 | Y if rental or over 1K Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1801 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1802 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1803 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1804 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1805 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1806 | treatment of joint stiffness and contractures unproven | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1807 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1808 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1810 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1811 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1812 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1813 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1814 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1815 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1816 | (e.g., joint active systems (JAS) devices) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1818 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1820 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1821 | forearm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1822 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1823 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1825 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1826 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1827 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1828 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1829 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1830 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1831 | E1832 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1832 | E1841 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1840 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1841 | Subchondroplasty/Subchondral Calcium 0707T Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1902 | Y if rental or over 1K Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E1905 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2000 | Not Required Not Required Y if rental or over 1K Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2001 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2100 | Y if rental or over 1K Not Required Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2101 | Y if rental or over 1K Not Required Y if rental or over 1K Y if rental or over 1K Not Required Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2102 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2103 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2104 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2120 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2201 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2202 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2203 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2204 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2205 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2206 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2207 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2208 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2209 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2210 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2211 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2212 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2213 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2214 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2215 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2216 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2217 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2218 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2219 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2220 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2221 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2222 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2224 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2225 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2226 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2227 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2228 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2230 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2231 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2291 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2292 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2293 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2294 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2295 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2298 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2300 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2301 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2310 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2311 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2312 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2313 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2321 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2322 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2323 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2324 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2325 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2326 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2327 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2328 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2329 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2330 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2331 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2340 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2341 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2342 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2343 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2351 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2358 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2359 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2360 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2361 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2362 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2363 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2364 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2365 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2366 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2367 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2368 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2369 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2370 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2371 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2372 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2373 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2374 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2375 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2376 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2377 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2378 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2381 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2382 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2383 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2384 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2385 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2386 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2387 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2388 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2389 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2390 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2391 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2392 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2394 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2395 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2396 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2397 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2398 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2402 | Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K Y for purchases over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2500 | Y if rental or over 1K Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2502 | Y if rental or over 1K Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2504 | Y if rental or over 1K Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2506 | Y if rental or over 1K Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2508 | Y if rental or over 1K Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2510 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2511 | Y if rental or over 1K Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2512 | Y if rental or over 1K Not Required Y if rental or over 1K Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2513 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2599 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2601 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2602 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2603 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2604 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2605 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2606 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2607 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2608 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2609 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2610 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2611 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2612 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2613 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2614 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2615 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2616 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2617 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2619 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2620 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2621 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2622 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2623 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2624 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2625 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2626 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2627 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2628 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2629 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2630 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2631 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2632 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E2633 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E3000 | Y if rental or over 1K Y if rental or over 1K Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E3200 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E8000 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E8001 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| E8002 | Y if rental or over 1K Y if rental or over 1K Not Required Required Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0027 | ( , ), and repeat semen analysis ( ) may be separately reimbursed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0108 | Diabetic Education ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0109 | Diabetic Education ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0123 | transplant or those with long-term | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0124 | transplant or those with long-term | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0127 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0141 | steroid use | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0143 | steroid use | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0144 | • Women beginning in adolescence | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0145 | • Women beginning in adolescence | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0147 | who have been diagnosed with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0148 | who have been diagnosed with | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0151 | • Physical Therapist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0152 | • Occupational Therapist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0153 | • Speech Therapist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0155 | • Medical Social Services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0156 | • Home Health Aide | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0159 | effective therapy (e.g., physical therapy, , occupational therapy, , and speech | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0160 | effective therapy (e.g., physical therapy, , occupational therapy, , and speech | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0161 | therapy, ) maintenance program in the home setting. However, no coverage will be | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0162 | • Registered Nurse (RN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0219 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0235 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0237 | • Respiratory Therapy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0238 | • Respiratory Therapy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0239 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0245 | CDPHP will not administer benefits for , , and (initial, follow-up and routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0246 | CDPHP will not administer benefits for , , and (initial, follow-up and routine | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0247 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0252 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0260 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0270 | • Nutritional Counseling | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0276 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0277 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0281 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0283 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0299 | • Registered Nurse (RN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0300 | • Licensed Practical Nurse (LPN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0308 | Required Not Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0309 | Required Not Required Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0320 | • Tele-homecare | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0321 | • Tele-homecare | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0322 | • Tele-homecare | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0327 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0329 | Modalities | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0339 | Stereotactic body radiosurgery: 77373, 77435 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0340 | Stereotactic body radiosurgery: 77373, 77435 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0341 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0342 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0343 | Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0398 | • Unattended (home-based) sleep testing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0399 | • Unattended (home-based) sleep testing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0400 | • Unattended (home-based) sleep testing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0422 | Intensive Cardiac Rehabilitation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0423 | Intensive Cardiac Rehabilitation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0428 | Not Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0429 | Not Required Not Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0432 | Allogeneic Hematopoietic Stem Cell 38205, 38240 Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0448 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0480 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0481 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0482 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0483 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0493 | • Registered Nurse (RN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0494 | • Licensed Practical Nurse (LPN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0495 | • Registered Nurse (RN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0496 | • Licensed Practical Nurse (LPN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0555 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0563 | Stereotactic body radiosurgery: 77373, 77435 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G0659 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2035 | • : Prenatal Screening | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2063 | • : Testing for Diagnosis of Active or Latent | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2067 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2068 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2070 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2071 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2072 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2073 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2074 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2075 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2076 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2077 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2078 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2079 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2080 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2086 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2087 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2088 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2121 | • : Laboratory Testing for the Diagnosis of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2125 | • : Urinary Tumor Markers for Bladder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2127 | • : Vectra DA Blood Test for Rheumatoid | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2130 | • : ST2 Assay for Chronic Heart Failure | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G2150 | • : Biomarkers for Myocardial Infarction and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9143 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9880 | 5 percent WL Achieved from baseline weight | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9881 | 9 percent WL Achieved from baseline weight | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9886 | Behavioral counseling for diabetes prevention, in-person | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9887 | Behavioral counseling for diabetes prevention, distance | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9888 | Maintenance 5 percent WL from baseline in months 7-12 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9890 | No change to effective added codes , which are allowable under the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| G9891 | No change to effective added codes , which are allowable under the | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0002 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0004 | Other Licensed Practitioner (OLP) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0015 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0020 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0033 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0034 | G2077, G2078, G2079, G2080, G2086, G2087, G2088, 96372, J0570, Q9991, Q9992 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0035 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0036 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0038 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H0040 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2011 | Other Licensed Practitioner (OLP) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2012 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2013 | Removed from Crisis Intervention Services (Crisis Residential | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2014 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2015 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2017 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2018 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2019 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2023 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| H2025 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0174 | HCPCS code Leqembi | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0175 | Kisunla | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0202 | Multiple Sclerosis Non-preferred: Lemtrada ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0217 | HCPCS | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0219 | Nexviazyme ( ): 100mg vial for reconstitution | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0220 | Availability Lumizyme ( & ): 50mg alglucosidase alfa as lyophilized powder in single dose vial | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0221 | Availability Lumizyme ( & ): 50mg alglucosidase alfa as lyophilized powder in single dose vial | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0222 | HCPCS: with positive genetics and known neuropathy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0223 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0225 | HCPCS: • A baseline Polyneuropathy disability (PND) score of IIIb or lower AND | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0248 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0256 | HCPCS codes Prolastin C: ; Glassia: ; Aralast: ; Zemaira | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0257 | HCPCS codes Prolastin C: ; Glassia: ; Aralast: ; Zemaira | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0491 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0517 | Eosinophilic Asthma Preferred: Nucala ( ), Fasenra ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0570 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0604 | equivalent or other form of administration other than an oral form. Prior to January 1, 2018 Sensipar (cinacalcet) met the definition | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0606 | under 42 CFR 413.234(a) and was paid under the Part D benefit. A new injectable drug, Parsabiv® ( , etelcalcetide), that falls within | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0775 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0791 | Adakveo (crizanlizumab) [HCPCS Code: ] is available as a 100-mg/10-mL intravenous infusion | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0881 | HCPCS: • Anemia Due to Chemotherapy in Patients with Cancer | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0885 | HCPCS: • Treatment of anemia due to chronic kidney disease (CKD) in patients on | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0896 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J0897 | Bone resorption agents Non-preferred: Prolia ( ), Bildyos (Qxxxx), Conexxence ( ), Jubbonti ( ), Ospomyv ( ), Stoboclo | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1096 | into lacrimal canaliculus and the drug Dextenza ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1203 | Pombiliti ( ): 105 mg cipaglucosidase alfa-atga as lyophilized powder in single dose vial | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1230 | Injectable methadone ( ) products are not approved for the outpatient treatment of opioid | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1301 | Availability Radicava: 30 mg/100 mL solution for injection ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1302 | J - Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1304 | Qalsody: Injection 100 mg/15 mL (6.7 mg/mL) solution in a single-dose vial ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1305 | 345mg/2.3mL (150mg/mL) and 1,200mg/8mL (150mg/mL) solution | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1306 | HCPCS Administration | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1411 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1426 | HCPCS codes Exondys 51: ; Vyondys 53: ; Viltepso: ; Amondys 45 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1427 | HCPCS codes Exondys 51: ; Vyondys 53: ; Viltepso: ; Amondys 45 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1428 | HCPCS codes Exondys 51: ; Vyondys 53: ; Viltepso: ; Amondys 45 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1429 | HCPCS codes Exondys 51: ; Vyondys 53: ; Viltepso: ; Amondys 45 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1442 | Disorders/Biosimilars – Non-preferred: Neupogen , Granix , Releuko , Nypozi | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1447 | Disorders/Biosimilars – Non-preferred: Neupogen , Granix , Releuko , Nypozi | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1448 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1449 | Disorders/Biosimilars – Non-preferred: Udenyca , Ziextenzo , Stimufend , Fylnetra , Rolvedon , Ryzneuta | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1551 | INJECTION, IMMUNE GLOBULIN (CUTAQUIG), 100MG | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1555 | INJECTION, IMMUNE GLOBULIN (CUVITRU), 100 MG | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1558 | INJECTION, IMMUNE GLOBULIN (XEMBIFY), 100 MG | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1559 | INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1561 | INJECTION, IMMUNE GLOBULIN, (GAMUNEX-C/GAMMAKED), NON-LYOPHILIZED (E.G., LIQUID), 500 MG | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1562 | INJECTION, IMMUNE GLOBULIN (VIVAGLOBIN), 100 MG | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1569 | INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILIZED, (E.G., LIQUID), 500 MG | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1575 | INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J1823 | Uplizna - inebilizumab-cdon (medical) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2182 | Eosinophilic Asthma Preferred: Nucala ( ), Fasenra ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2323 | Preferred: Tysabri ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2326 | HCPCS code (Spinraza) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2506 | Blood Preferred: Neulasta , Fulphila , Nyvepria | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2781 | HCPCS | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2782 | HCPCS | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2786 | Non-preferred: Cinqair ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2802 | HCPCS Code Nplate – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2860 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J2998 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3241 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3357 | determined that more than 50% of all use is self-administered and claims will no longer be paid under Part B with a J code . Claims will | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3393 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3394 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3398 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3399 | J – Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3401 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3489 | Preferred: Zoledronic Acid ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3490 | HCPCS Code Prevymis: (no specific HCPCS Code) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J3590 | Disorders/Biosimilars – Non-preferred: Neupogen , Granix , Releuko , Nypozi | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7170 | HCPCS Codes Hemlibra | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7172 | Hympavzi | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7173 | Alhemo | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7174 | Qfitlia | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7189 | HCPCS codes (Novoseven RT), (Alprolix), (Idelvion), (Rebinyn), (Esperoct), (Eloctate) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7201 | HCPCS codes (Novoseven RT), (Alprolix), (Idelvion), (Rebinyn), (Esperoct), (Eloctate) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7202 | HCPCS codes (Novoseven RT), (Alprolix), (Idelvion), (Rebinyn), (Esperoct), (Eloctate) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7203 | HCPCS codes (Novoseven RT), (Alprolix), (Idelvion), (Rebinyn), (Esperoct), (Eloctate) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7204 | HCPCS codes (Novoseven RT), (Alprolix), (Idelvion), (Rebinyn), (Esperoct), (Eloctate) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7205 | HCPCS codes (Novoseven RT), (Alprolix), (Idelvion), (Rebinyn), (Esperoct), (Eloctate) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7207 | (Adynovate), (Jivi), (SevenFact) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7208 | (Adynovate), (Jivi), (SevenFact) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7212 | (Adynovate), (Jivi), (SevenFact) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7318 | Non-preferred: Durolane: ( ); Genvisc 850: ( ); Supartz FX: ( ); Hymovis: ( ); Euflexxa | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7320 | Non-preferred: Durolane: ( ); Genvisc 850: ( ); Supartz FX: ( ); Hymovis: ( ); Euflexxa | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7321 | Non-preferred: Durolane: ( ); Genvisc 850: ( ); Supartz FX: ( ); Hymovis: ( ); Euflexxa | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7322 | Non-preferred: Durolane: ( ); Genvisc 850: ( ); Supartz FX: ( ); Hymovis: ( ); Euflexxa | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7323 | ( ); Synvisc-One: ( ); Gelsyn-3: ( ); Trivisc: ( ); Triluron: ( ), Hyalgan ( ), Visco-3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7324 | Osteoarthritis Preferred: Gel-One ( ), Monovisc ( ) and Orthovisc ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7325 | ( ); Synvisc-One: ( ); Gelsyn-3: ( ); Trivisc: ( ); Triluron: ( ), Hyalgan ( ), Visco-3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7326 | Osteoarthritis Preferred: Gel-One ( ), Monovisc ( ) and Orthovisc ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7327 | Osteoarthritis Preferred: Gel-One ( ), Monovisc ( ) and Orthovisc ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7328 | ( ); Synvisc-One: ( ); Gelsyn-3: ( ); Trivisc: ( ); Triluron: ( ), Hyalgan ( ), Visco-3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7329 | ( ); Synvisc-One: ( ); Gelsyn-3: ( ); Trivisc: ( ); Triluron: ( ), Hyalgan ( ), Visco-3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7330 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7331 | ( ), SynoJoint ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7332 | ( ); Synvisc-One: ( ); Gelsyn-3: ( ); Trivisc: ( ); Triluron: ( ), Hyalgan ( ), Visco-3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7336 | Availability Qutenza (capsaicin) 8% contains 179 mg per patch | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7352 | J-Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7401 | 4/1/21 Removed termed code and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7402 | Mometasone furoate sinus implant, 10 micrograms (Sinuva™) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7799 | NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J7999 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9035 | Biosimilars Non-preferred: Avastin ( ), Alymsys ( ) Vegzelma ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9311 | Biosimilars Non-preferred: Rituxan ( ), Rituxan Hycela ( ), Riabni ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9312 | Biosimilars Non-preferred: Rituxan ( ), Rituxan Hycela ( ), Riabni ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9333 | HCPCS Code Rystiggo | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9355 | Biosimilars Non-preferred: Herceptin ( ), Herceptin Hylecta ( ), Ogivri ( ), Herzuma ( ), Ontruzant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9356 | Biosimilars Non-preferred: Herceptin ( ), Herceptin Hylecta ( ), Ogivri ( ), Herzuma ( ), Ontruzant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9361 | longer acting | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9376 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| J9381 | HCPCS Code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0001 | • Standard wheelchair rental ( - ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0007 | • Standard wheelchair rental ( - ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0553 | codes and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0554 | codes and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0606 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0607 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0608 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0609 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0800 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0801 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0806 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0808 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0826 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0831 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0835 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0836 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0850 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0858 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0860 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0861 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0862 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K0903 | 2/1/2020 Removed termed code and added code for shoe | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1001 | Removed termed code and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1002 | Removed termed code and replaced it with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1013 | 1/1/2024 Replaced termed code with new code in Select | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1015 | date of policy for this Removed termed code and replaced with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1016 | Removed termed code and replaced it with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1018 | Removed termed code and replaced it with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1020 | Removed termed code and replaced it with new code | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1023 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1027 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1028 | Removed termed codes and and replaced them | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1029 | Removed termed codes and and replaced them | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1030 | Contractility modulation generator - external Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1031 | Removed termed codes , , and and replaced | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1032 | Removed termed codes , , and and replaced | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| K1033 | Removed termed codes , , and and replaced | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L0456 | • The following orthotic codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L0464 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1007 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1200 | • Scoliosis jacket/Thoracic Lumbar Sacral Orthoses (TLSO) ( , , ) when | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1210 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1300 | • Scoliosis jacket/Thoracic Lumbar Sacral Orthoses (TLSO) ( , , ) when | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1310 | • Scoliosis jacket/Thoracic Lumbar Sacral Orthoses (TLSO) ( , , ) when | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1499 | Suit Therapy (i.e., Theratogs, TheraSuit, Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1832 | • - Jace Tri-brace | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1845 | • - Bledsoe brace | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1852 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1900 | • Ankle foot orthotic (AFO) codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1902 | • Ankle foot orthotic (AFO) codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1904 | • Ankle foot orthotic (AFO) codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1906 | • Ankle foot orthotic (AFO) codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1907 | • Ankle foot orthotic (AFO) codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1910 | • Ankle foot orthotic (AFO) codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1920 | • Ankle foot orthotic (AFO) codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1930 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1932 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1940 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1945 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1950 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1951 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1960 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1970 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1971 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1980 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L1990 | L2106, L2108, L2112, L2114, L2116, L2200, L2210, L2220, L2230, L2232, L2240, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2106 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2108 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2112 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2114 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2116 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2200 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2210 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2220 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2230 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2232 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2240 | L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2250 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2260 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2265 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2270 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2275 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2280 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2300 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2310 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2320 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2330 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2335 | L2340, L2350, L2360, L2370,L2375, L4002, L4090, L4205, L4210, L4350, L4360, | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2340 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2350 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2360 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2370 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2375 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2755 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L2840 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L3000 | • CDPHP will provide coverage for custom foot orthotics ( - ) in lieu of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L3030 | • CDPHP will provide coverage for custom foot orthotics ( - ) in lieu of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L3041 | Determination: Physical Medicine and Rehabilitation ( ), Accessed 5/1/06 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L3161 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L3760 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L3960 | • – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L3984 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4002 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4090 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4205 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4210 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4350 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4360 | L4361, L4370, L4386, L4387, L4392, L4394, L4396, L4397, L4398, L4631 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4361 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4370 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4386 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4387 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4392 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4394 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4396 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4397 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4398 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L4631 | • L3960 – Airplane splint/shoulder | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5020 | • The following orthotic codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5301 | • The following orthotic codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5321 | • The following orthotic codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5460 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5585 | • The following orthotic codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5611 | • The following orthotic codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5618 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5620 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5624 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5632 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5636 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5643 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5649 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5651 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5657 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5673 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5681 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5700 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5701 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5705 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5781 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5828 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5840 | L5845, L5856, L5964, L5968, L5973, L5981, L5987, L5988, L6110, L6721, L6884 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5845 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5856 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5910 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5925 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5940 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5964 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5968 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5969 | B. A microprocessor-controlled ankle-foot with power assist ( AND ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5972 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5973 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5981 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5987 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L5988 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6000 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6010 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6020 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6034 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6035 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6036 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6038 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6039 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6050 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6055 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6100 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6110 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6120 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6130 | Upper limb prostheses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6200 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6205 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6250 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6300 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6310 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6320 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6350 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6360 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6370 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6400 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6450 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6500 | L6550): | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6550 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6680 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6698 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6721 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L6884 | & MEDICAL SUPPLIES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L7400 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L7520 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L7700 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L7900 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L7902 | Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8015 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8035 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8435 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8605 | Required Not Required Not Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8607 | Required Not Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8614 | Cochlear device, includes all internal and external components | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8615 | Replacement components of cochlear implant device/system (code range) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8619 | Code Description | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8621 | Replacement batteries used with cochlear implant device/system (code range) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8624 | Code Description | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8625 | External recharging system for battery for use with cochlear implant or auditory | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8627 | Cochlear implant, external speech processor, component, replacement | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8628 | Cochlear implant, external controller component, replacement | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8680 | A device ( - , - ) that is used to electrically stimulate a member’s spinal | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8683 | A device ( - , - ) that is used to electrically stimulate a member’s spinal | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8685 | A device ( - , - ) that is used to electrically stimulate a member’s spinal | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8689 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8690 | Auditory osseointegrated device, includes all internal and external components | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8691 | Auditory osseointegrated device, external sound processor, excludes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8693 | Auditory osseointegrated device, abutment, any length, replacement only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8699 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8701 | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| L8702 | Required Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M0075 | Not Required Not Required Not Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M0076 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M0300 | Required Not Required Not Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2027 | Neoplasms and removed archived policies: BCR - ABL 1 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2037 | • : Genetic Testing for Familial Cutaneous | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2039 | for PGT in accordance with criteria outlined in policy, – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2062 | Testing and Genetic Testing for Acute Myeloid Leukemia | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2066 | Genetic Cancer Susceptibility Using Next Generation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2084 | • : Genetic Testing for Mental Health | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2109 | 6/14/2022 Removed obsolete policy Molecular Panel Testing of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2111 | • : Multigene Expression Assay for Predicting | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2178 | 3/15/2022 New policy added to the list of tests reviewed by Avalon | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2179 | • : Prenatal Screening (Genetic) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2180 | • : Genetic Markers for Assessing Risk of | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| M2182 | 3/1/2024 New policy added: Genomic Testing for Hematopoietic | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| P3000 | cervical dysplasia or cervical cancer | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| P3001 | cervical dysplasia or cervical cancer | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| P4177 | Journal of Clinical Endocrinology and Metabolism. Vol. 82, No. 12, Dec. 1998, pp | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| P4188 | 3. Crain, J.; Wilmer, K.; Steuerwald, N.; Young, E.: Transactions of the Sixteenth Annual | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q0091 | • Sexually active women beginning in | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2026 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2041 | chemoimmunotherapy | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2042 | second or later relapse | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2043 | ICD10 diagnosis codes | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2053 | precursor acute lymphoblastic leukemia (ALL) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2054 | lymphoma), high-grade B-cell lymphoma, primary | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2055 | immunotherapy inhibitor, and an anti-CD38 monoclonal antibody | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2056 | immunotherapy immunomodulatory agent, and are refractory to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q2058 | Breyanzi® (lisocabtagene 2021 CD19-directed genetically Adult patients with large B-cell lymphoma (LBCL), | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4100 | Skin substitute, not otherwise specified | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4101 | Apligraf, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4102 | Oasis wound matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4103 | (E/I) Oasis burn matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4104 | (E/I) Integra bilayer matrix wound dressing (BMWD), per square cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4105 | Integra dermal regeneration template (DRT) or Integra Omnigraft dermal | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4106 | Dermagraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4107 | GRAFTJACKET, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4108 | Integra matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4110 | (E/I) PriMatrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4111 | (E/I) GammaGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4112 | (E/I) Cymetra, injectable, 1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4113 | (E/I) GRAFTJACKET XPRESS, injectable, 1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4114 | (E/I) Integra flowable wound matrix, injectable, 1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4115 | (E/I) AlloSkin, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4116 | AlloDerm, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4117 | (E/I) HYALOMATRIX, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4118 | (E/I) MatriStem micromatrix, 1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4121 | TheraSkin, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4122 | DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4123 | (E/I) AlloSkin RT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4124 | (E/I) OASIS ultra tri-layer wound matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4125 | (E/I) ArthroFlex, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4126 | (E/I) MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4127 | (E/I) Talymed, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4128 | FlexHD, AllopatchHD, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4130 | (E/I) Strattice TM, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4132 | Grafix Core and GrafixPL Core, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4133 | Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4134 | (E/I) HMatrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4135 | (E/I) Mediskin, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4136 | (E/I) E-Z Derm, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4137 | (E/I) AmnioExcel, AmnioExcel Plus or BioDExcel, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4138 | (E/I) BioDFence DryFlex, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4139 | (E/I) AmnioMatrix or BioDMatrix, injectable, 1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4140 | (E/I) BioDFence, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4141 | (E/I) AlloSkin AC, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4142 | (E/I) XCM biologic tissue matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4143 | (E/I) Repriza, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4145 | (E/I) EpiFix, injectable, 1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4146 | (E/I) Tensix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4147 | (E/I) Architect, Architect PX, or Architect FX, extracellular matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4148 | (E/I) Neox Cord 1K, Neox Cord RT, or Clarix Cord 1K, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4149 | (E/I) Excellagen, 0.1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4150 | (E/I) AlloWrap DS or dry, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4151 | AmnioBand or Guardian, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4152 | (E/I) DermaPure, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4153 | (E/I) Dermavest and Plurivest, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4154 | Biovance, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4155 | (E/I) Neox Flo or Clarix Flo, 1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4156 | (E/I) Neox 100 or Clarix 100, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4157 | (E/I) Revitalon, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4158 | (E/I) Kerecis Omega3, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4159 | (E/I) Affinity, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4160 | (E/I) NuShield, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4161 | (E/I) Bio-ConneKt wound matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4162 | (E/I) WoundEx Flow, BioSkin Flow, 0.5 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4163 | (E/I) WoundEx, BioSkin, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4164 | (E/I) Helicoll, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4165 | (E/I) Keramatrix or Kerasorb, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4166 | (E/I) Cytal, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4167 | (E/I) Truskin, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4168 | (E/I) AmnioBand, 1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4169 | (E/I) Artacent wound, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4170 | (E/I) Cygnus, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4171 | (E/I) Interfyl, 1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4172 | • Removed termed code from Exclusions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4173 | (E/I) PalinGen or PalinGen Xplus, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4174 | (E/I) PalinGen or ProMatrX, 0.36 mg per 0.25 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4175 | (E/I) Miroderm, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4176 | (E/I) Neopatch or therion, per square centimeter | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4177 | (E/I) FlowerAmnioFlo, 0.1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4178 | (E/I) FlowerAmnioPatch, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4179 | (E/I) FlowerDerm, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4180 | (E/I) Revita, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4181 | (E/I) Amnio Wound, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4182 | Transcyte, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4183 | (E/I) Surgigraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4184 | (E/I) Cellesta or Cellesta Duo, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4185 | (E/I) Cellesta Flowable Amnion (25 mg per cc); per 0.5 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4186 | Epifix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4187 | Epicord, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4188 | (E/I) AmnioArmor, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4189 | (E/I) Artacent AC, 1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4190 | (E/I) Artacent AC, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4191 | (E/I) Restorigin, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4192 | (E/I) Restorigin, 1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4193 | (E/I) Coll-e-Derm, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4194 | (E/I) Novachor, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4195 | (E/I) PuraPly, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4196 | (E/I) PuraPly AM, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4197 | (E/I) PuraPly XT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4198 | (E/I) Genesis Amniotic Membrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4199 | (E/I) Cygnus matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4200 | (E/I) SkinTE, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4201 | (E/I) Matrion, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4202 | (E/I) Keroxx (2.5 g/cc), 1cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4203 | (E/I) Derma-Gide, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4204 | (E/I) XWRAP, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4205 | (E/I) Membrane Graft or Membrane Wrap, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4206 | (E/I) Fluid Flow or Fluid GF, 1 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4208 | (E/I) Novafix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4209 | (E/I) SurGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4211 | (E/I) Amnion Bio or axoBioMembrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4212 | (E/I) AlloGen, per cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4213 | (E/I) Ascent, 0.5 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4214 | (E/I) Cellesta Cord per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4215 | (E/I) Axolotl Ambient or Axolotl Cryo, 0.1 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4216 | (E/I) Artacent Cord, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4217 | (E/I) WoundFix, BioWound, WoundFix Plus, BioWound Plus, WoundFix Xplus or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4218 | (E/I) SurgiCORD, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4219 | (E/I) SurgiGRAFT-DUAL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4220 | (E/I) BellaCell HD or Surederm, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4221 | (E/I) Amnio Wrap2, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4222 | (E/I) ProgenaMatrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4224 | (E/I) Human Health Factor 10 Amniotic Patch (HHF10-P), per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4225 | (E/I) AmnioBind, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4226 | (E/I) MyOwn Skin, includes harvesting and preparation procedures, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4227 | (E/I) AmnioCore TM, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4229 | (E/I) Cogenex Amniotic Membrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4230 | (E/I) Cogenex Flowable Amnion, per 0.5 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4231 | (E/I) Corplex P, per cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4232 | (E/I) Corplex, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4233 | (E/I) SurFactor or NuDyn, per 0.5 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4234 | (E/I) XCellerate, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4235 | (E/I) AMNIOREPAIR or AltiPly, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4236 | (E/I) CarePATCH, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4237 | (E/I) Cryo-Cord, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4238 | (E/I) Derm-Maxx, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4239 | (E/I) Amnio-Maxx or Amnio-Maxx Lite, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4240 | (E/I) CoreCyte, for topical use only, per 0.5 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4241 | (E/I) PolyCyte, for topical use only, per 0.5 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4242 | (E/I) AmnioCyte Plus, per 0.5 cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4245 | (E/I) AmnioText, per cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4246 | (E/I) CoreText or ProText, per cc | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4247 | (E/I) Amniotext patch, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4248 | (E/I) Dermacyte Amniotic Membrane Allograft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4249 | (E/I) AMNIPLY, for topical use only, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4250 | (E/I) AmnioAmp-MP, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4251 | (E/I) VIM per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4252 | (E/I) Vendaje, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4253 | (E/I) Zenith Amniotic Membrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4254 | (E/I) Novafix DL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4255 | (E/I) REGUaRD, for topical use only, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4256 | (E/I) MLG-Complete, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4257 | (E/I) Relese, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4258 | (E/I) Enverse, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4259 | (E/I) Celera Dual Layer or Celera Dual Membrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4260 | (E/I) Signature APatch, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4261 | (E/I) TAG, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4262 | (E/I) Dual Layer Impax Membrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4263 | (E/I) SurGraft TL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4264 | (E/I) Cocoon Membrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4265 | (E/I) NeoStim TL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4266 | (E/I) NeoStim Membrane, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4267 | (E/I) NeoStim DL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4268 | (E/I) SurGraft FT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4269 | (E/I) SurGraft XT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4270 | (E/I) Complete SL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4271 | (E/I) Complete FT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4272 | (E/I) Esano A, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4273 | (E/I) Esano AAA, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4274 | (E/I) Esano AC, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4275 | (E/I) Esano ACA, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4276 | (E/I) ORION, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4278 | (E/I) EPEFFEICT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4279 | (E/I) Vendaje AC, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4280 | (E/I) Xcell Amnio Matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4281 | (E/I) Barrera SL or Barrera DL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4282 | (E/I) Cygnus Dual, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4283 | (E/I) Biovance Tri-Layer or Biovance 3L, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4284 | (E/I) DermaBind SL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4285 | (E/I) NuDYN DL or NuDYN DL MESH, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4286 | (E/I) NuDYN SL or NuDYN SLW, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4287 | (E/I) DermaBind DL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4288 | (E/I) DermaBind CH, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4289 | (E/I) RevoShield+ Amniotic Barrier, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4290 | (E/I) Membrane Wrap-Hydro, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4291 | (E/I) Lamellas XT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4292 | (E/I) Lamellas, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4293 | (E/I) Acesso DL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4294 | (E/I) Amnio Quad-Core, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4295 | (E/I) Amnio Tri-Core Amniotic, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4296 | (E/I) Rebound Matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4297 | (E/I) Emerge Matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4298 | (E/I) AmniCore Pro, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4299 | (E/I) AmniCore Pro+, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4300 | (E/I) Acesso TL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4301 | (E/I) Activate Matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4302 | (E/I) Complete ACA, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4303 | (E/I) Complete AA, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4304 | (E/I) GRAFIX PLUS, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4305 | (E/I) American Amnion AC Tri-Layer, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4306 | (E/I) American Amnion AC, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4307 | (E/I) American Amnion, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4308 | (E/I) Sanopellis, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4309 | (E/I) VIA Matrix, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4310 | (E/I) Procenta, per 100 mg | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4311 | (E/I) Acesso, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4312 | (E/I) Acesso AC, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4313 | (E/I) DermaBind FM, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4314 | (E/I) Reeva FT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4315 | (E/I) RegeneLink Amniotic Membrane Allograft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4316 | (E/I) AmchoPlast, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4317 | (E/I) VitoGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4318 | (E/I) E-Graft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4319 | (E/I) SanoGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4320 | (E/I) PelloGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4321 | (E/I) RenoGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4322 | (E/I) CaregraFT, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4323 | (E/I) alloPLY, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4324 | (E/I) AmnioTX, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4325 | (E/I) ACApatch, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4326 | (E/I) WoundPlus, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4327 | (E/I) DuoAmnion, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4328 | (E/I) MOST, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4329 | (E/I) Singlay, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4330 | (E/I) TOTAL, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4331 | (E/I) Axolotl Graft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4332 | (E/I) Axolotl DualGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4333 | (E/I) ArdeoGraft, per sq cm | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4334 | (E/I) AmnioPlast 1, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4335 | (E/I) AmnioPlast 2, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4336 | (E/I) Artacent C, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4337 | (E/I) Artacent Trident, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4338 | (E/I) Artacent Velos, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4339 | (E/I) Artacent Vericlen, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4340 | (E/I) SimpliGraft, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4341 | (E/I) SimpliMax, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4342 | (E/I) TheraMend, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4343 | (E/I) Dermacyte AC Matrix Amniotic Membrane Allograft, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4344 | (E/I) Tri-Membrane Wrap, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4345 | (E/I) Matrix HD Allograft Dermis, per sq cm (effective 10/01/24) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4346 | (E/I) Shelter DM Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4347 | (E/I) Rampart DL Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4348 | (E/I) Sentry SL Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4349 | (E/I) Mantle DL Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4350 | (E/I) Palisade DM Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4351 | (E/I) Enclose TL Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4352 | (E/I) Overlay SL Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4353 | (E/I) Xceed TL Matrix, per sq cm (effective 01/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4354 | (E/I) Palingen dual-layer membrane, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4355 | (E/I) Abiomend xplus membrane and abiomend xplus hydromembrane, per square | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4356 | (E/I) Abiomend membrane and abiomend hydromembrane, per square centimeter | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4357 | (E/I) Xwrap plus, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4358 | (E/I) Xwrap dual, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4359 | (E/I) Choriply, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4360 | (E/I) Amchoplast fd, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4361 | (E/I) Epixpress, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4362 | (E/I) Cygnus disk, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4363 | (E/I) Amnio burgeon membrane and hydromembrane, per square centimeter (effective | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4364 | (E/I) Amnio burgeon xplus membrane and xplus hydromembrane, per square centimeter | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4365 | (E/I) Amnio burgeon dual-layer membrane, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4366 | (E/I) Dual layer amnio burgeon x-membrane, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4367 | (E/I) Amniocore sl, per square centimeter (effective 04/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4368 | (E/I) AmchoThick, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4369 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4370 | (E/I) AeroGuard, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4371 | (E/I) NeoGuard, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4372 | (E/I) AmchoPlast EXCEL, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4373 | (E/I) Membrane Wrap-Lite, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4375 | (E/I) duoGRAFT AC, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4376 | (E/I) Duograft AA, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4377 | (E/I) triGRAFT FT, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4378 | (E/I) Renew FT Matrix, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4379 | (E/I) AmnioDefend FT Matrix, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4380 | (E/I) AdvoGraft One, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4382 | (E/I) AdvoGraft Dual, per sq cm (effective 07/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4383 | (E/I) Axolotl Graft Ultra, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4384 | (E/I) Axolotl DualGraft Ultra, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4385 | (E/I) Apollo FT, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4386 | (E/I) Acesso TrifACA, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4387 | (E/I) NeoThelium FT, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4388 | (E/I) NeoThelium 4L, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4389 | (E/I) NeoThelium 4L Plus, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4390 | (E/I) Ascendion, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4391 | (E/I) AmnioPlast Double, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4392 | (E/I) GRAFIX Duo, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4393 | (E/I) SurGraft AC, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4394 | (E/I) SurGraft ACA, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4395 | (E/I) Acelagraft, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4396 | (E/I) Natalin, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4397 | (E/I) Summit AAA, per sq cm (effective 10/01/25) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4398 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4399 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4400 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4401 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4402 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4403 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4404 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4405 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4406 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4407 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4408 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4409 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4410 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4411 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4412 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4413 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4414 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4415 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4416 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4417 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q4420 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5101 | Blood Preferred: Zarxio , Nivestym | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5106 | HCPCS: • Reduction of allogeneic red blood cell transfusions in patients undergoing | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5107 | Preferred: Mvasi ( ), Zirabev ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5108 | Blood Preferred: Neulasta , Fulphila , Nyvepria | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5110 | Blood Preferred: Zarxio , Nivestym | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5111 | Disorders/Biosimilars – Non-preferred: Udenyca , Ziextenzo , Stimufend , Fylnetra , Rolvedon , Ryzneuta | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5112 | ( ), Hercessi ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5113 | Biosimilars Non-preferred: Herceptin ( ), Herceptin Hylecta ( ), Ogivri ( ), Herzuma ( ), Ontruzant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5114 | Biosimilars Non-preferred: Herceptin ( ), Herceptin Hylecta ( ), Ogivri ( ), Herzuma ( ), Ontruzant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5115 | Preferred: Ruxience ( ), Truxima ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5116 | Preferred: Trazimera ( ), Kanjinti ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5117 | Preferred: Trazimera ( ), Kanjinti ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5118 | Preferred: Mvasi ( ), Zirabev ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5119 | Preferred: Ruxience ( ), Truxima ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5120 | Disorders/Biosimilars – Non-preferred: Udenyca , Ziextenzo , Stimufend , Fylnetra , Rolvedon , Ryzneuta | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5122 | Blood Preferred: Neulasta , Fulphila , Nyvepria | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5123 | Biosimilars Non-preferred: Rituxan ( ), Rituxan Hycela ( ), Riabni ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5125 | Disorders/Biosimilars – Non-preferred: Neupogen , Granix , Releuko , Nypozi | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5126 | Biosimilars Non-preferred: Avastin ( ), Alymsys ( ) Vegzelma ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5127 | Disorders/Biosimilars – Non-preferred: Udenyca , Ziextenzo , Stimufend , Fylnetra , Rolvedon , Ryzneuta | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5129 | Biosimilars Non-preferred: Avastin ( ), Alymsys ( ) Vegzelma ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5130 | Disorders/Biosimilars – Non-preferred: Udenyca , Ziextenzo , Stimufend , Fylnetra , Rolvedon , Ryzneuta | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5136 | Bone resorption agents Non-preferred: Prolia ( ), Bildyos (Qxxxx), Conexxence ( ), Jubbonti ( ), Ospomyv ( ), Stoboclo | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5146 | ( ), Hercessi ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5157 | ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5158 | Bone resorption agents Non-preferred: Prolia ( ), Bildyos (Qxxxx), Conexxence ( ), Jubbonti ( ), Ospomyv ( ), Stoboclo | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5159 | Bone resorption agents Non-preferred: Prolia ( ), Bildyos (Qxxxx), Conexxence ( ), Jubbonti ( ), Ospomyv ( ), Stoboclo | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q5160 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q9991 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| Q9992 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0002 | non-invasive tests. Am J Surg. 2020 Nov 25: -9610(20) -4 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0140 | phase 3 trial. Lancet. 2020 Sep 12;396( ):759-769. doi: 10.1016/ -6736(20) -X. Epub | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0189 | • Testopel is billed with code and will require PA review. Testopel will | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0207 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0390 | Routine Foot Care ( , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0515 | Contact lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0741 | https://www.jvascsurg.org/article/ -5214(11) -2/pdf | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0800 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S0810 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1030 | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1031 | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1034 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1035 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1036 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1037 | ( , , , , , , , , , , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1040 | Cranial Remolding Orthosis ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1091 | Stent, non-coronary, temporary, with delivery system (Propel™) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S1474 | multicentre, phase 3 trial. Lancet Neurol. 2021 Apr;20(4):284-293. doi: 10.1016/ -4422(21) -6 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2050 | 2019 Sep 17. pii: -1161(19) -3 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2053 | Transplantation of small intestine, and liver allografts | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2054 | Transplantation of multivisceral organs | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2065 | Simultaneous pancreas kidney transplantation | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2066 | S2067 S2068 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2067 | 19316 Mastopexy (breast lift) to treat | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2068 | 19316 Mastopexy (breast lift) to treat | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2080 | •Laser-assisted uvulopalatoplasty (LAUP) ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2083 | Adjustment of gastric band diameter via subcutaneous port by injection or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2102 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2117 | Subtalar arthroereisis for the treatment of Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2118 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2120 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2142 | Cord blood-derived stem-cell transplantation, allogeneic | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2150 | Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2235 | Implantation of auditory brainstem implant | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2348 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2350 | Required through Health Help Required through Health Help Not Required Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2405 | review. Eur Urol Focus. 2021 Mar 1: -4569(21) -0 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S2666 | Therapy. Transplant Cell Ther. 2024 Sep 20: -6367(24) -1 | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3800 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3840 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3841 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3842 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3844 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3845 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3846 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3849 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3850 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3852 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3853 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3854 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3861 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3865 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3866 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3870 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3890 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S3900 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S4013 | • Gamete intrafallopian transfer (GIFT) and follicle aspiration ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S4014 | • Zygote intrafallopian transfer (ZIFT) ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5125 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5126 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5130 | • Personal Care Aide Level I (Homemaker/Housekeeper) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5150 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5151 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5160 | • Personal emergency response system | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5161 | • Personal emergency response system | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S5165 | 7/1/24 Removed codes for EMods, VMods, and AAT ( , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8035 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8037 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8042 | Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help Required through Health Help | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8080 | Not Required Not Required Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8092 | Not Required Required Not Required Not Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8130 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8131 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8420 | The following codes will be allowed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8428 | The following codes will be allowed | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8940 | Hippotherapy ( ), as scientific evidence is insufficient to determine the effects of this | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8948 | Low-level or high-level laser therapy Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S8990 | (NMN) Physical or manipulative therapy performed for maintenance rather than | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9001 | Uterine activity monitoring; home setting Covered when performed during an | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9055 | Required Not Required Required Required Not Required Not Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9090 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9110 | Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K Y if rental or over 1K | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9122 | • Home Health Aide | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9123 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9124 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9127 | • Medical Social Services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9128 | • Speech Therapist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9129 | • Occupational Therapist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9131 | • Physical Therapist | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9208 | inpatient hospitalization only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9349 | Tocolytic infusion therapy; home setting Experimental, investigational, or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9465 | Diabetic Education ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9470 | • Nutritional Counseling | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9472 | Removed from the list of Exclusions | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9473 | such as | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9480 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9484 | Crisis Intervention (CI), including Crisis Residential Services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9485 | Crisis Intervention (CI), including Crisis Residential Services | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9500 | Home infusion therapy (HCPCS) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9501 | Home infusion therapy (HCPCS) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9502 | Home infusion therapy (HCPCS) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9503 | Home infusion therapy (HCPCS) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9504 | Home infusion therapy (HCPCS) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9960 | wheelchair van and/or private or commercial air transportation ( – , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9961 | wheelchair van and/or private or commercial air transportation ( – , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9988 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9990 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9991 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9992 | Required Not Required Not Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9994 | Required Not Required Not Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| S9996 | Not Required Not Required Not Required Required Not Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1000 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1001 | • : RN Supervisory Visit | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1002 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1003 | Not Required Not Required Required Not Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1014 | • Tele-homecare | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1015 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1019 | • Personal Care Aide Level II | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1020 | • Personal Care Aide Level II | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1021 | • Home Health Aide | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1030 | • Registered Nurse (RN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T1031 | • Licensed Practical Nurse (LPN) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2013 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2015 | • : Prescription Medication and Illicit Drug | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2017 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2019 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2020 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2024 | Assessment/Plan of Care Development: (Billed to | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2028 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2034 | PROCEDURE CODES | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| T2039 | 7/1/24 Removed codes for EMods, VMods, and AAT ( , , and | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2020 | Frames – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2025 | • Deluxe frame ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2100 | Single vision lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2121 | Single vision lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2200 | Lens: Bifocal lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2221 | Lens: Bifocal lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2300 | Trifocal lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2321 | Trifocal lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2410 | Variable asphericity lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2430 | Variable asphericity lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2500 | Contact lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2520 | Corneal liquid bandage encompasses the use of both therapeutic soft contact lenses ( | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2521 | ) and rigid gas permeable scleral contact lenses ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2522 | ) and rigid gas permeable scleral contact lenses ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2523 | ) and rigid gas permeable scleral contact lenses ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2530 | ) and rigid gas permeable scleral contact lenses ( , , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2531 | Contact lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2623 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2626 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2627 | ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2628 | Required Required Required Required Required Required | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2630 | Intraocular lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2632 | Intraocular lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2702 | • Deluxe lens feature ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2744 | • Tinted lenses ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2745 | • Tinted lenses ( , ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2750 | • Antireflective coating ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2755 | • U-V lens ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2760 | • Scratch-resistant coating ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2761 | • Mirror coating ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2762 | • Polarization ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2780 | • Oversized lenses ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2781 | Progressive lens ( ) are considered an acceptable alternative to standard bifocals or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2782 | • High index glass or plastic ( , ) lenses for indications such as lightweight or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2783 | • High index glass or plastic ( , ) lenses for indications such as lightweight or | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2784 | Lenses made of polycarbonate ( ) are covered for enrollees with functional vision in only | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2786 | • Specialty occupational multifocal lenses ( ) | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2787 | Intraocular lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2788 | Intraocular lenses – | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |
| V2790 | Amniotic membrane for surgical reconstruction, per procedure | 2026-07-01 | 2022-10-01 | 97% | [PDF] CDPHP Policies List - AWS |